1881883148 NPI number — THREE RIVERS CONSULTING & MANAGEMENT ,LLC

Table of content: (NPI 1881883148)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881883148 NPI number — THREE RIVERS CONSULTING & MANAGEMENT ,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THREE RIVERS CONSULTING & MANAGEMENT ,LLC
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:
6
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:
1881883148
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
621 S PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROKEN BOW
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74728-5331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
580-351-6577
Provider Business Mailing Address Fax Number:
580-501-0853

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
621 S PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROKEN BOW
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74728-5331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-501-0850
Provider Business Practice Location Address Fax Number:
580-501-0853
Provider Enumeration Date:
10/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EDWARDS
Authorized Official First Name:
LOLA
Authorized Official Middle Name:
JANE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
805-584-6608

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  37-1692 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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