Three Rivers Radiology, LLC

Primary specialty

Vascular & Interventional Radiology PhysicianTaxonomy code 2085R0204X

License

99057753A Issued in IN

Legal business name

THREE RIVERS RADIOLOGY, LLC

Practice address

6819 Lima Rd
Suite 200
Fort Wayne, IN 46818-1145

Phone

(260) 407-6200

NPI assigned

Jul 2, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Carey Gross

Title

President & Treasurer

Phone

(260) 467-9716

Specialties & licenses 9

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1372723200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372723200000",
    "number": "1306286513",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8712",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468988712"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6819 LIMA RD",
            "address_2": "SUITE 200",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468181145",
            "telephone_number": "260-407-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THREE RIVERS RADIOLOGY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-02",
        "last_updated": "2013-07-02",
        "status": "A",
        "authorized_official_last_name": "GROSS",
        "authorized_official_first_name": "CAREY",
        "authorized_official_title_or_position": "PRESIDENT & TREASURER",
        "authorized_official_telephone_number": "260-467-9716",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": "IN",
            "license": "99057753A",
            "primary": false
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": "IN",
            "license": "99057753A",
            "primary": false
        },
        {
            "code": "2085B0100X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Body Imaging",
            "state": "IN",
            "license": "99057753A",
            "primary": false
        },
        {
            "code": "2085D0003X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Neuroimaging",
            "state": "IN",
            "license": "99057753A",
            "primary": false
        },
        {
            "code": "2085N0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Neuroradiology",
            "state": "IN",
            "license": "99057753A",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IN",
            "license": "99057753A",
            "primary": false
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "IN",
            "license": "99057753A",
            "primary": true
        },
        {
            "code": "2085U0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Radiology, Diagnostic Ultrasound",
            "state": "IN",
            "license": "99057753A",
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": "IN",
            "license": "99057753A",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Vascular & Interventional Radiology Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Vascular & Interventional Radiology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.