| Organization Name: | THREE RIVERS HEALTH |
| NPI Number: | 1396720579 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WILLIAM RUSSELL (PRACTICE MANAGEMENT) |
| Mailing Address: | 711 S Health Pkwy Suite 4 Three Rivers |
| State: | MI US |
| Postal Code: | 490939387 |
| Phone Number: | 2692781265 |
| Fax Number: | 2692732454 |
| NPI Enumeration Date: | 12/12/2005 |
| NPI Last Update Date: | 01/24/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207QA0505X |
| License Number: | 750020 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Family Medicine |
| Taxonomy Specialization: | Adult Medicine |
| Taxonomy Definition: | |