Provider Demographics
NPI:1710041124
Name:THREE RIVERS DISTRICT HEALTH DEPT
Entity Type:Organization
Organization Name:THREE RIVERS DISTRICT HEALTH DEPT
Other - Org Name:THREE RIVERS PUBLIC HEALTH DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER OF OPERATIONS
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRA
Authorized Official - Middle Name:L
Authorized Official - Last Name:UHING
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:402-727-5396
Mailing Address - Street 1:2400 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2461
Mailing Address - Country:US
Mailing Address - Phone:402-727-5396
Mailing Address - Fax:402-727-5399
Practice Address - Street 1:2400 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2461
Practice Address - Country:US
Practice Address - Phone:402-727-5396
Practice Address - Fax:402-727-5399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2012-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251K00000X
NE251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE099736Medicare ID - Type Unspecified
NEP00271282Medicare ID - Type UnspecifiedRAILROAD MEDICARE