Three Rivers Medical Associates, LLC

Primary specialty

Nephrology PhysicianTaxonomy code 207RN0300X

License

01052976A Issued in IN

Legal business name

THREE RIVERS MEDICAL ASSOCIATES, LLC

Practice address

7910 W Jefferson Blvd
Fort Wayne, IN 46804-4159

Phone

(260) 402-7446

Fax

(260) 435-7007

NPI assigned

Sep 21, 2006

Last updated

Oct 24, 2007By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Binoy Ouseph, MD

Title

Office Manager

Phone

(260) 402-7446

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1193184000000",
    "number": "1558460378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2331 LADUE LANE",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "46804",
            "telephone_number": "260-402-7446",
            "fax_number": "260-435-7007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7910 W JEFFERSON BLVD",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468044159",
            "telephone_number": "260-402-7446",
            "fax_number": "260-435-7007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THREE RIVERS MEDICAL ASSOCIATES, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2007-10-24",
        "status": "A",
        "authorized_official_last_name": "OUSEPH",
        "authorized_official_first_name": "BINOY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "260-402-7446",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207RN0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Nephrology",
            "state": "IN",
            "license": "01052976A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Raja V Thotakura, M.D.
• Three Rivers Ambulance Authority
• Three Rivers Anesthesia, LLC
• Three Rivers Dermatology, LLC (Three Rivers Dermatology)
• Three Rivers Home Car Services LLC
• Three Rivers Radiology, LLC
• Three Rivers Surgical Associates
• Three Rivers Surgical Associates, LLC
• Three Rivers Therapy LLC
• Threelovebugs, LLC (Lice Clinics of America Ft. Wayne)

• Nephrology Physician in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Nephrology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2007; 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.