Provider Demographics
NPI:1366406597
Name:THREE RIVERS PATHOLOGY LLP
Entity type:Organization
Organization Name:THREE RIVERS PATHOLOGY LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROWELL
Authorized Official - Last Name:CUMMINGS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-586-6445
Mailing Address - Street 1:PO BOX 100559
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-0559
Mailing Address - Country:US
Mailing Address - Phone:843-664-4300
Mailing Address - Fax:843-664-4308
Practice Address - Street 1:203 W 8TH AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-5630
Practice Address - Country:US
Practice Address - Phone:509-586-6445
Practice Address - Fax:509-586-5183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-14
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00020519207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7101520Medicaid
WA7101520Medicaid
WAGAB14267Medicare PIN
WACG6123Medicare PIN