Organization
THREE RIVERS HEALTH SYSTEM, INC
Active
Parent organization
THREE RIVERS HEALTH SYSTEM, INC
Other names
West Michigan Ear, Nose and Throat
Organization subpart
Yes
Provider details
NPI number
Legal business name
THREE RIVERS HEALTH SYSTEM, INC
Authorized official
JEFFERY COSTELLO (CFO)
(574) 647-3460
Entity
Organization
Contact information
Practice address
3850 GLENKERRY CT, PORTAGE, MI 49024-0700
(269) 327-7200
(269) 327-9272
Mailing address
3245 HEALTH DR STE 100, GRANGER, IN 46530-1380
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
—
207YX0905X
Otolaryngology/Facial Plastic Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942669296
—
MI
Enumeration date
02/15/2016
Last updated
07/22/2024
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