Three Rivers Medical Center

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

9700722 Issued in NC

Legal business name

THREE RIVERS MEDICAL CENTER

Practice address

580 W. McLean St.
St. Pauls, NC 28384

Phone

(910) 865-3063

Fax

(918) 653-5063

NPI assigned

Jan 9, 2007

Last updated

Jun 17, 2009By 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

Raju B Raval, D.O.

Title

Administrator

Phone

(910) 484-5366

Specialties & licenses 3

Addresses

Other identifiers 1

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

{
    "created_epoch": "1168300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245196800000",
    "number": "1720137037",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "580 W MCLEAN ST.",
            "city": "ST. PAULS",
            "state": "NC",
            "postal_code": "28384",
            "telephone_number": "910-865-3063",
            "fax_number": "910-865-3503"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "580 W. MCLEAN ST.",
            "city": "ST. PAULS",
            "state": "NC",
            "postal_code": "28384",
            "telephone_number": "910-865-3063",
            "fax_number": "918-653-5063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THREE RIVERS MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-09",
        "last_updated": "2009-06-17",
        "status": "A",
        "authorized_official_last_name": "RAVAL",
        "authorized_official_first_name": "RAJU",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "910-484-5366",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "100548",
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "9700722",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89011VU",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Southeastern Regional Physician Services (St. Pauls Medical Clinic)
• Spring Village Rest Home Inc
• Sunesis Comprehensive Care, PLLC (Primary Care of St. Pauls)
• Rachel Sutton, LCSWA
• Tarheel Diabetic and Medical Supply, Inc
• Town of St. Pauls (St Pauls Volunteer EMS)
• Transportation With Mo Inc (Your Reliable Designated Driver)
• VRC Counseling Agency, PLLC
• Wal-Mart Stores East LP (Walmart Pharmacy 10-7329)
• Walgreen Co (Walgreens #16171)

• Internal Medicine Physician in Saint Pauls, NC
• Providers in Saint Pauls, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2009; 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.