Provider Demographics
NPI:1831529379
Name:THREE RIVERS SPINE & PAIN MEDICINE
Entity type:Organization
Organization Name:THREE RIVERS SPINE & PAIN MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-919-2077
Mailing Address - Street 1:PO BOX 791
Mailing Address - Street 2:
Mailing Address - City:CARNEGIE
Mailing Address - State:PA
Mailing Address - Zip Code:15106-0791
Mailing Address - Country:US
Mailing Address - Phone:412-655-4362
Mailing Address - Fax:412-653-7684
Practice Address - Street 1:249 THREE SPRINGS DR
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-3814
Practice Address - Country:US
Practice Address - Phone:304-919-2077
Practice Address - Fax:304-914-4374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-20
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD425965208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty