Provider Demographics
NPI:1720005671
Name:THREE RIVERS SURGICAL SPECIALISTS, INC.
Entity Type:Organization
Organization Name:THREE RIVERS SURGICAL SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROCKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-466-8916
Mailing Address - Street 1:575 COAL VALLEY RD
Mailing Address - Street 2:SUITE 277
Mailing Address - City:JEFFERSON HILLS
Mailing Address - State:PA
Mailing Address - Zip Code:15025-3730
Mailing Address - Country:US
Mailing Address - Phone:412-466-8916
Mailing Address - Fax:412-346-0078
Practice Address - Street 1:575 COAL VALLEY RD
Practice Address - Street 2:SUITE 277
Practice Address - City:JEFFERSON HILLS
Practice Address - State:PA
Practice Address - Zip Code:15025-3730
Practice Address - Country:US
Practice Address - Phone:412-466-8916
Practice Address - Fax:412-346-0078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018411910002Medicaid
PA0018411910002Medicaid