Provider Demographics
NPI:1205108586
Name:THREE RIVERS HEALTH SYSTEM, INC
Entity type:Organization
Organization Name:THREE RIVERS HEALTH SYSTEM, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSSELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-273-9601
Mailing Address - Street 1:677 E MAIN ST STE B
Mailing Address - Street 2:P.O. BOX 310
Mailing Address - City:CENTREVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49032-8525
Mailing Address - Country:US
Mailing Address - Phone:269-467-9011
Mailing Address - Fax:269-467-9511
Practice Address - Street 1:677 E MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:CENTREVILLE
Practice Address - State:MI
Practice Address - Zip Code:49032-8525
Practice Address - Country:US
Practice Address - Phone:269-467-9011
Practice Address - Fax:269-467-9511
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THREE RIVERS HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-02
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI750020261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health