Basic Information
| Provider Information | |||||||||
| NPI: | 1598760951 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | THREE RIVERS OB/GYN ASSOCIATES, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1301 TAYLOR ST | ||||||||
| Address2: | STE 7B | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292012972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032549461 | ||||||||
| FaxNumber: | 8032549318 | ||||||||
| Practice Location | |||||||||
| Address1: | 1301 TAYLOR ST | ||||||||
| Address2: | STE 7B | ||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292012972 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8032549461 | ||||||||
| FaxNumber: | 8032549318 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2005 | ||||||||
| LastUpdateDate: | 10/25/2007 | ||||||||
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| AuthorizedOfficialLastName: | JOHNSON | ||||||||
| AuthorizedOfficialFirstName: | JAMES | ||||||||
| AuthorizedOfficialMiddleName: | H. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8032549461 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 8251 | SC | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.