# THREE RIVERS MEDICAL ASSOCIATES, PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1760445597
- **Authorized official:** DR. JOHN GOULD III DO (PRESIDENT)
- **Authorized official phone:** (839) 200-7510

## Contact information

- **Practice address:** 7430 COLLEGE ST, IRMO, SC 29063-2903
- **Practice address phone:** (839) 200-7510
- **Practice address fax:** (803) 891-7085
- **Mailing address:** 7430 COLLEGE ST, IRMO, SC 29063-2903
- **Mailing address phone:** (839) 200-7510
- **Mailing address fax:** (803) 891-7085

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | — |
| 207Q00000X | Family Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | Yes |
| 207R00000X | Internal Medicine Physician | — | — | Yes |
| 363LF0000X | Family Nurse Practitioner | — | NULL | — |
| 363LF0000X | Family Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 04/11/2006
- **Last updated:** 01/12/2022