THREE RIVERS HEALTH SYSTEM, INC (NPI# 1942669296) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942669296 |
| Entity Type | Organization |
| Organization Name | THREE RIVERS HEALTH SYSTEM, INC |
| Other Organization Name | WEST MICHIGAN EAR, NOSE AND THROAT |
| Practice Address |
3850 Glenkerry Ct Portage MI 49024-0700 |
| Practice Telephone | 2693277200 |
| Practice Fax Number | 2693279272 |
| Mailing Telephone | 2693277200 |
| Mailing Fax Number | 2693279272 |
| Enumeration Date | 2016-02-15 |
| Last Update Date | 2016-02-15 |
| Authorized Official Name | WILLIAM RUSSELL (CEO) |
| Authorized Official Telephone | 2692739601 |
| Is Organization Subpart | Y |
| Parent Organization Name | THREE RIVERS HEALTH SYSTEM, INC |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Y00000X | Otolaryngology | Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| West Michigan Ear, Nose and Throat | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1124390307 | Three Rivers Health System, Inc | Podiatrist | 1021 Hill St Ste 300, Three Rivers, MI 49093-2744 | 2012-02-02 |
| 1346874070 | Three Rivers Health System, Inc | Internal Medicine | 715 S Health Pkwy, Three Rivers, MI 49093-8352 | 2020-03-03 |
| 1821631334 | Three Rivers Health System, Inc | Clinic/Center | 16587 Enterprise Dr, Three Rivers, MI 49093-7902 | 2019-10-28 |
| 1427608785 | Three Rivers Health System, Inc | Nutritionist | 701 S Health Pkwy, Three Rivers, MI 49093-8352 | 2019-09-18 |
| 1376196691 | Three Rivers Health System, Inc | Social Worker | 1101 Jefferson St, Three Rivers, MI 49093-1024 | 2019-07-17 |
| 1174065767 | Three Rivers Health System, Inc | Plastic Surgery | 1021 Hill St, Suite 300, Three Rivers, MI 49093-2745 | 2016-11-14 |
| 1790144079 | Three Rivers Health System, Inc | Family Medicine | 850 S Health Pkwy, Three Rivers, MI 49093-8358 | 2016-02-16 |
| 1992197925 | Three Rivers Health System, Inc | Podiatrist | 7971 Moorsbridge Rd, Portage, MI 49024-4075 | 2015-02-27 |
| 1093113151 | Three Rivers Health System, Inc | Family Medicine | 850 S Health Pkwy, Three Rivers, MI 49093-8358 | 2014-12-05 |
| 1245668383 | Three Rivers Health System, Inc | Clinic/Center | 110 E Main St, Marcellus, MI 49067-5102 | 2013-10-29 |
| Street Address |
3850 GLENKERRY CT |
| City | PORTAGE |
| State | MI |
| Zip Code | 49024-0700 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154365849 | West Michigan Ear Nose & Throat Plc | Otolaryngology | 3850 Glenkerry Ct, Portage, MI 49024 | 2006-06-15 |
| 1902387962 | Amelia Louise Evenhouse | Physician Assistant | 3850 Glenkerry Ct, Portage, MI 49024-0700 | 2018-08-27 |
| 1215111885 | Douglas John Raedy | Otolaryngology | 3850 Glenkerry Ct, Portage, MI 49024-0700 | 2007-12-19 |
| 1922295732 | Lynette Marie Burkett | Audiologist | 3850 Glenkerry Ct, Portage, MI 49024-0700 | 2007-09-26 |
| 1861415002 | Melissa Ann Dusseljee | Physician Assistant | 3850 Glenkerry Ct, Portage, MI 49024-0700 | 2006-07-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134774524 | Antonio Richard Barron | Physician Assistant | 5717 Oakland Dr Ste A, Portage, MI 49024 | 2019-08-03 |
| 1699279240 | Julie Lynn Griffin | Specialist/Technologist | Portage Northern High School, 1000 Idaho Ave, Portage, MI 49024 | 2018-03-20 |
| 1194255711 | Brittany Lynn Finkler | Audiologist | 576 Romence Rd Ste 121, Portage, MI 49024 | 2017-06-15 |
| 1164881207 | Family & Children Services, Inc. | Clinic/Center | 1302 W Milham Ave, Portage, MI 49024 | 2016-02-17 |
| 1497127716 | Huber Counseling, LLC | Counselor | 1591 West Centre Ave, Suite 102, Portage, MI 49024 | 2015-10-26 |
| 1659757466 | Marie Porter | Rehabilitation Practitioner | 5724 Alten St, Portage, MI 49024 | 2015-08-04 |
| 1063824860 | George Hughes | General Practice | 6630 Sunburst Dr, Portage, MI 49024 | 2014-05-28 |
| 1922358407 | Kimberly Lynn Ellrich | Speech-Language Pathologist | Storypoint, 3951 W Milham Ave, Portage, MI 49024 | 2012-09-12 |
| 1942593744 | Shamika Hall, Ph.d. & Associates, Pllc | Community/Behavioral Health | 7901 S. 12th St., Suite 201, Portage, MI 49024 | 2011-05-26 |
| 1306142815 | Jody Lynn Wrathall | Dentist | 3020 Old Centre Rd, Portage, MI 49024 | 2011-01-31 |
| Find all providers in zip 49024 | ||||
| Taxonomy Code | 207Y00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Otolaryngology |
| An otolaryngologist-head and neck surgeon provides comprehensive medical and surgical care for patients with diseases and disorders that affect the ears, nose, throat, the respiratory and upper alimentary systems and related structures of the head and neck. An otolaryngologist diagnoses and provides medical and/or surgical therapy or prevention of diseases, allergies, neoplasms, deformities, disorders and/or injuries of the ears, nose, sinuses, throat, respiratory and upper alimentary systems, face, jaws and the other head and neck systems. Head and neck oncology, facial plastic and reconstructive surgery and the treatment of disorders of hearing and voice are fundamental areas of expertise. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Otolaryngology, 2007. http://www.aboto.org/. American Osteopathic Board of Ophthalmology and Otolaryngology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Otolaryngology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Ophthalmology and Otolaryngology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154365849 | West Michigan Ear Nose & Throat Plc | Otolaryngology | 3850 Glenkerry Ct, Portage, MI 49024 | 2006-06-15 |
| 1215111885 | Douglas John Raedy | Otolaryngology | 3850 Glenkerry Ct, Portage, MI 49024-0700 | 2007-12-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104445980 | Anuja Dharap | Otolaryngology | 35630 Grand River Ave Apt 217, Farmington Hills, MI 48335-3120 | 2020-04-13 |
| 1598311334 | Cogent Medical Group Pllc | Otolaryngology | 28300 Orchard Lake Rd Ste 101, Farmington Hills, MI 48334-3704 | 2019-08-16 |
| 1073025334 | Robert J Stachler Md PC | Otolaryngology | 33200 W. 14 Mile Rd., Ste. 240, West Bloomfield, MI 48322 | 2017-10-26 |
| 1255878062 | W.a. Foote Memorial Hospital, Inc | Otolaryngology | 205 N.east Ave, Jackson, MI 49201 | 2017-01-31 |
| 1174905822 | Scott Jacob Schwartz | Otolaryngology | 6900 Orchard Lake Rd Ste 314, West Bloomfield, MI 48322-3457 | 2015-06-18 |
| 1669868402 | Cameron M Heilbronn | Otolaryngology | 21000 E 12 Mile Rd Ste 111, Saint Clair Shores, MI 48081-1156 | 2015-04-08 |
| 1104230523 | Gary Zachary White | Otolaryngology | 300 North Ave Ste 1400, Battle Creek, MI 49017 | 2014-06-13 |
| 1437574530 | Beacon Medical Group, Inc. | Otolaryngology | 711 S Health Pkwy Ste 1, Medical Office Building #1, Three Rivers, MI 49093-8354 | 2014-02-26 |
| 1124361621 | Eric Fahed Succar | Otolaryngology | 44200 Woodward Ave Ste 201, Pontiac, MI 48341-5045 | 2013-04-03 |
| 1396086286 | Nathan Vandjelovic | Otolaryngology | 4201 Saint Antoine St # 9c, Detroit, MI 48201-2153 | 2013-03-03 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.