Three Rivers Health System, Inc
Organization Active NPI Foot & Ankle Surgery Podiatrist · Portage, MI
NPI 1992197925 · NPPES record last updated Jul 22, 2024
Key facts
- NPI
- 1992197925
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Foot & Ankle Surgery Podiatrist 213ES0103X
- Legal business name
- THREE RIVERS HEALTH SYSTEM, INC
- Practice address
- 7971 Moorsbridge Rd
Portage, MI 49024-4075 - Phone
- (269) 323-2094
- Fax
- (269) 323-2095
- NPI assigned
- Feb 27, 2015
- Organization subpart
- Yes
- Parent organization (as reported)
- THREE RIVERS HEALTH SYSTEM, INC
Authorized official
- Name
- Jeffery Costello
- Title
- Cfo
- Phone
- (574) 647-3460
Parent organization (reported in NPPES) 1
Other NPIs on the same Medicare enrollment 23
Practitioners 3
-
Steven J Cowing, PA-C
-
Michael A. Howell, DPM
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140729001948 | MI | Part B Supplier - Clinic/Group Practice | 8729245584 |
Receives reassigned benefits from 71 practitioners 23 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Portage, MI; Three Rivers, MI; White Pigeon, MI |
National Provider Directory
- Part of
- Three Rivers Health System Inc
Locations
6901 N Main St
Granger, IN 46530
Phone (574) 647-2900
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Podiatrist |
213E00000X | |||
| Foot & Ankle Surgery Podiatrist |
213ES0103X | Yes |
Addresses
Primary practice location
7971 Moorsbridge Rd
Portage, MI 49024-4075
Mailing address
3245 Health Dr Ste 100
Granger, IN 46530-1380
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992197925 | Medicaid | MI |
Other names
- Kalamazoo Foot & Ankle Specialists
Other providers in Portage, MI
- Charles Thomas
- Madison Thomas
- Taylor Thompson
- Heidi Rebecca Thorpe
- Three Rivers Health System, Inc
- David B Thrower
- Kamaria Tilley
- Timothy J Howard Associates, LLC
- TLC Laser Center of Kalamazoo, LLC
- Brodi Tobolski
All providers in Portage, MI · Foot & Ankle Surgery Podiatrist in Michigan
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 22, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.