Basic Information
| Provider Information | |||||||||
| NPI: | 1699038737 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THREE RIVERS MEDICAL CLINICS INC | ||||||||
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| OtherOrganizationName: | THREE RIVERS FAMILY PRACTICE - INEZ | ||||||||
| 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: | 94 BOARDWALK | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | INEZ | ||||||||
| State: | KY | ||||||||
| PostalCode: | 412247003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6062982660 | ||||||||
| FaxNumber: | 6062982662 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2012 | ||||||||
| LastUpdateDate: | 03/07/2014 | ||||||||
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| AuthorizedOfficialLastName: | ARWOOD | ||||||||
| AuthorizedOfficialFirstName: | SOPHIA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 6156286038 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | THREE RIVERS MEDICAL CLINICS INC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | KY | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.