Three Rivers Medical Associates, PA

Organization Active NPI Internal Medicine Physician · Columbia, SC

NPI 1194468538 · NPPES record last updated Apr 14, 2022

Key facts

NPI
1194468538
Entity type
Organization (NPI type 2)
Primary specialty
Internal Medicine Physician 207R00000X
Legal business name
THREE RIVERS MEDICAL ASSOCIATES, PA
Practice address
1931 Bull St
Columbia, SC 29201-2560
Phone
(839) 200-7822
Fax
(803) 891-7085
NPI assigned
Apr 14, 2022
Organization subpart
No

Authorized official

Name
John Gould III, MD
Title
President
Phone
(839) 200-7810

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Corporate family (same tax ID) 4

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in SC

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20031210000142 SC Part B Supplier - Clinic/Group Practice 1557267663 Receives reassigned benefits from 19 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Columbia, SC; Irmo, SC

National Provider Directory

Tax ID family
Three Rivers Medical Associates PA (5 organizations share this tax ID)

Locations

1931 Bull St
Columbia, SC 29201
Phone (803) 767-4832

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP
207R00000X Yes

Addresses

Primary practice location

1931 Bull St
Columbia, SC 29201-2560

Mailing address

1931 Bull St
Columbia, SC 29201-2560
Phone (839) 200-7822

Other providers in Columbia, SC

All providers in Columbia, SC · Internal Medicine Physician in South Carolina

Sources for this page

Verify at the official NPI Registry.