Provider Demographics
NPI:1851425789
Name:THREE RIVERS CLINIC LLC
Entity Type:Organization
Organization Name:THREE RIVERS CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:KERR
Authorized Official - Suffix:
Authorized Official - Credentials:BSCS
Authorized Official - Phone:406-285-3251
Mailing Address - Street 1:PO BOX 1078
Mailing Address - Street 2:
Mailing Address - City:THREE FORKS
Mailing Address - State:MT
Mailing Address - Zip Code:59752-1078
Mailing Address - Country:US
Mailing Address - Phone:406-285-3251
Mailing Address - Fax:406-285-6742
Practice Address - Street 1:16 RAILWAY AVE
Practice Address - Street 2:
Practice Address - City:THREE FORKS
Practice Address - State:MT
Practice Address - Zip Code:59752-1078
Practice Address - Country:US
Practice Address - Phone:406-285-3251
Practice Address - Fax:406-285-6742
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-100560261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT29346OtherSTATE
MTQ56585Medicare UPIN
MT29346OtherSTATE
MT273824Medicare Oscar/Certification