Provider Demographics
NPI:1316955909
Name:THREE RIVERS EYE CARE CENTER, PC
Entity type:Organization
Organization Name:THREE RIVERS EYE CARE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:A
Authorized Official - Last Name:STERN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-543-9200
Mailing Address - Street 1:1200 SOUTH RESERVE STREET
Mailing Address - Street 2:SUITE H
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59801-3701
Mailing Address - Country:US
Mailing Address - Phone:406-543-9200
Mailing Address - Fax:406-543-9222
Practice Address - Street 1:1200 SOUTH RESERVE STREET
Practice Address - Street 2:SUITE H
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-3701
Practice Address - Country:US
Practice Address - Phone:406-543-9200
Practice Address - Fax:406-543-9222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8180302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT95001OtherBCBS
MT0169507Medicaid
MT0035581Medicaid
MT0005120600OtherAETNA
MT0035581Medicaid
MTDN9107Medicare PIN
MT0169507Medicaid
MT000082448Medicare PIN