1952586927 NPI number — HERITAGE VALLEY MEDICAL GROUP, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952586927 NPI number — HERITAGE VALLEY MEDICAL GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HERITAGE VALLEY MEDICAL GROUP, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952586927
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 PEARTREE WAY
Provider Second Line Business Mailing Address:
TRI-STATE MEDICAL GROUP INC
Provider Business Mailing Address City Name:
BEAVER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-728-4171
Provider Business Mailing Address Fax Number:
724-728-2019

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 SHARON RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
BEAVER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15009-3148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-774-5030
Provider Business Practice Location Address Fax Number:
724-774-5040
Provider Enumeration Date:
01/08/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MITRY
Authorized Official First Name:
NORMAN
Authorized Official Middle Name:
F.
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
724-773-4776

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X , with the licence number:  020430 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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