Provider Demographics
NPI:1700265899
Name:GIMIVA, PA
Entity Type:Organization
Organization Name:GIMIVA, PA
Other - Org Name:THREE RIVERS INTEGRATED MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:VERRI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:412-444-4455
Mailing Address - Street 1:2121 NOBLESTOWN RD
Mailing Address - Street 2:SUTE 115
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15205-3956
Mailing Address - Country:US
Mailing Address - Phone:412-444-4455
Mailing Address - Fax:412-207-8522
Practice Address - Street 1:2121 NOBLESTOWN RD
Practice Address - Street 2:SUTE 115
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-3956
Practice Address - Country:US
Practice Address - Phone:412-444-4455
Practice Address - Fax:412-207-8522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420259363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMD420259OtherSTATE LICENSE