Provider Demographics
NPI:1902081631
Name:THREE RIVERS HEALTH
Entity Type:Organization
Organization Name:THREE RIVERS HEALTH
Other - Org Name:THREE RIVERS HEALTH INTERNAL MEDICINE II
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:269-273-9601
Mailing Address - Street 1:711 S HEALTH PKWY
Mailing Address - Street 2:SUITE L-7
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-9387
Mailing Address - Country:US
Mailing Address - Phone:269-273-9723
Mailing Address - Fax:269-273-9746
Practice Address - Street 1:655 S ERIE ST
Practice Address - Street 2:
Practice Address - City:THREE RIVERS
Practice Address - State:MI
Practice Address - Zip Code:49093-2060
Practice Address - Country:US
Practice Address - Phone:269-279-2120
Practice Address - Fax:269-273-3067
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THREE RIVERS HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI750020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty