Provider Demographics
NPI:1386602332
Name:THREE RIVERS ENDOSCOPY CENTER, INC.
Entity type:Organization
Organization Name:THREE RIVERS ENDOSCOPY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:E
Authorized Official - Last Name:STINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-262-1000
Mailing Address - Street 1:725 CHERRINGTON PARKWAY
Mailing Address - Street 2:STE 101
Mailing Address - City:MOON TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:15108-4305
Mailing Address - Country:US
Mailing Address - Phone:412-262-1000
Mailing Address - Fax:412-262-4607
Practice Address - Street 1:725 CHERRINGTON PARKWAY
Practice Address - Street 2:STE 101
Practice Address - City:MOON TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:15108-4305
Practice Address - Country:US
Practice Address - Phone:412-262-1000
Practice Address - Fax:412-262-4607
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-01
Last Update Date:2017-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA391061261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001652309Medicaid
PA001652309Medicaid