1720005671 NPI number — THREE RIVERS SURGICAL SPECIALISTS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720005671 NPI number — THREE RIVERS SURGICAL SPECIALISTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THREE RIVERS SURGICAL SPECIALISTS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720005671
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
575 COAL VALLEY RD
Provider Second Line Business Mailing Address:
SUITE 277
Provider Business Mailing Address City Name:
JEFFERSON HILLS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15025-3730
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
412-466-8916
Provider Business Mailing Address Fax Number:
412-346-0078

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
575 COAL VALLEY RD
Provider Second Line Business Practice Location Address:
SUITE 277
Provider Business Practice Location Address City Name:
JEFFERSON HILLS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15025-3730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
412-466-8916
Provider Business Practice Location Address Fax Number:
412-346-0078
Provider Enumeration Date:
07/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROCKE
Authorized Official First Name:
ALICE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
412-466-8916

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0018411910002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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