Basic Information
| Provider Information | |||||||||
| NPI: | 1669882916 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THREE RIVERS MEDICAL CLINICS INC | ||||||||
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| OtherOrganizationName: | THREE RIVERS FAMILY PRACTICE-CRUM | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 689022 | ||||||||
| Address2: | |||||||||
| City: | FRANKLIN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370689022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6154657585 | ||||||||
| FaxNumber: | 6154653007 | ||||||||
| Practice Location | |||||||||
| Address1: | 47460 ROUTE 52 | ||||||||
| Address2: | |||||||||
| City: | KERMIT | ||||||||
| State: | WV | ||||||||
| PostalCode: | 256748052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043936901 | ||||||||
| FaxNumber: | 3043936902 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2014 | ||||||||
| LastUpdateDate: | 05/07/2014 | ||||||||
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| AuthorizedOfficialLastName: | WRIGHT | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | SR. DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6154657587 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | THREE RIVERS MEDICAL CLINICS INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.