NPIMap

Organization Active NPI

Three Rivers Health Authority

  • Rural Health Clinic/Center
  • Centreville, MI
National Provider Identifier
1508840596
Registry record updated Apr 4, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
License
750020 Issued in MI
Legal business name
THREE RIVERS HEALTH AUTHORITY
Practice address
677 E Main St Ste B
Centreville, MI 49032-8525
Phone
(269) 467-9011
Fax
(269) 467-9511
NPI assigned
Dec 2, 2005
Organization subpart
Yes
Parent organization
THREE RIVERS HEALTHAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 4, 2013

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

Authorized official

Name
William Russell
Title
Ceo/President
Phone
(269) 273-9601

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X 750020 MI Primary

Addresses

Primary practice location

677 E Main St Ste B
Centreville, MI 49032-8525

Mailing address

701 S Health Pkwy
Medical Staff Office
Three Rivers, MI 49093-8352
Phone (269) 273-9789

Other identifiers 1

IdentifierTypeStateIssuer
700G560080OtherMIBCBSM

Other names 1

  • Three Rivers Health Family Care Centreville Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Three Rivers Health System Inc26 organizations share this tax ID, including this one
Part of
Three Rivers Health Anesthesia

Other organizations with this tax ID 25

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

View all 25

Locations

677 E Main St
Ste B
Centreville, MI 49032
Phone (269) 467-9011

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1133481600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365033600000",
    "number": "1508840596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "701 S HEALTH PKWY",
            "address_2": "MEDICAL STAFF OFFICE",
            "city": "THREE RIVERS",
            "state": "MI",
            "postal_code": "490938352",
            "telephone_number": "269-273-9789",
            "fax_number": "269-273-9611"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "677 E MAIN ST STE B",
            "city": "CENTREVILLE",
            "state": "MI",
            "postal_code": "490328525",
            "telephone_number": "269-467-9011",
            "fax_number": "269-467-9511"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THREE RIVERS HEALTH AUTHORITY",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THREE RIVERS HEALTH",
        "enumeration_date": "2005-12-02",
        "last_updated": "2013-04-04",
        "status": "A",
        "authorized_official_last_name": "RUSSELL",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_title_or_position": "CEO/PRESIDENT",
        "authorized_official_telephone_number": "269-273-9601"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "MI",
            "license": "750020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSM",
            "identifier": "700G560080",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Three Rivers Health Family Care Centreville",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Centreville, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 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.