Organization
THREE RIVERS RADIOLOGY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CAREY GROSS (PRESIDENT & TREASURER)
(260) 467-9716
Entity
Organization
Contact information
Practice address
6819 LIMA RD, SUITE 200, FORT WAYNE, IN 46818-1145
(260) 407-6200
Mailing address
PO BOX 8712, FORT WAYNE, IN 46898-8712
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
99057753A
IN
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
99057753A
IN
2085B0100X
Body Imaging Physician
99057753A
IN
2085D0003X
Diagnostic Neuroimaging (Radiology) Physician
99057753A
IN
2085N0700X
Neuroradiology Physician
99057753A
IN
2085R0202X
Diagnostic Radiology Physician
99057753A
IN
2085R0204X
Vascular & Interventional Radiology Physician
Primary
99057753A
IN
2085U0001X
Diagnostic Ultrasound Physician
99057753A
IN
208VP0014X
Interventional Pain Medicine Physician
99057753A
IN
Other
Enumeration date
07/02/2013
Last updated
07/02/2013
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