Organization
THREE RIVERS MEDICAL ASSOCIATES, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN GOULD III DO (PRESIDENT)
(839) 200-7510
Entity
Organization
Contact information
Practice address
7430 COLLEGE ST, IRMO, SC 29063-2903
(839) 200-7510
(803) 891-7085
Mailing address
7430 COLLEGE ST, IRMO, SC 29063-2903
(839) 200-7510
(803) 891-7085
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB9366
RAILROAD MEDICARE
SC
05
—
GP1314
—
SC
Enumeration date
04/11/2006
Last updated
01/12/2022
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