Provider Demographics
NPI:1023612504
Name:THREE RIVERS CLINIC, LLC
Entity type:Organization
Organization Name:THREE RIVERS CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR / PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLEY
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:HUFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-309-4143
Mailing Address - Street 1:158 HINTON BYP
Mailing Address - Street 2:
Mailing Address - City:HINTON
Mailing Address - State:WV
Mailing Address - Zip Code:25951-9184
Mailing Address - Country:US
Mailing Address - Phone:304-309-4143
Mailing Address - Fax:304-309-4146
Practice Address - Street 1:158 HINTON BYP
Practice Address - Street 2:
Practice Address - City:HINTON
Practice Address - State:WV
Practice Address - Zip Code:25951-9184
Practice Address - Country:US
Practice Address - Phone:304-309-4143
Practice Address - Fax:304-309-4146
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-25
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care