Provider Demographics
NPI:1073548145
Name:TRI-STATE ORTHOPAEDICS & SPORTS MEDICINE, INC.
Entity Type:Organization
Organization Name:TRI-STATE ORTHOPAEDICS & SPORTS MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:J
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-369-4000
Mailing Address - Street 1:5900 CORPORATE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15237-7005
Mailing Address - Country:US
Mailing Address - Phone:412-369-4000
Mailing Address - Fax:412-369-7667
Practice Address - Street 1:5900 CORPORATE DR
Practice Address - Street 2:SUITE 200
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15237-7005
Practice Address - Country:US
Practice Address - Phone:412-369-4000
Practice Address - Fax:412-369-7667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2021-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA139618OtherHIGHMARK GROUP NUMBER
PA0194350001Medicare NSC
PA139618Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER