Provider Demographics
NPI: | 1528015401 |
---|---|
Name: | HERITAGE VALLEY MULTISPECIALTY GROUP, INC. |
Entity Type: | Organization |
Organization Name: | HERITAGE VALLEY MULTISPECIALTY GROUP, INC. |
Other - Org Name: | TRI STATE MEDICAL GROUP INC |
Other - Org Type: | Former Legal Business Name |
Authorized Official - Title/Position: | PRESIDENT & CEO |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | NORMAN |
Authorized Official - Middle Name: | F |
Authorized Official - Last Name: | MITRY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 724-773-4776 |
Mailing Address - Street 1: | 200 OHIO RIVER BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | BADEN |
Mailing Address - State: | PA |
Mailing Address - Zip Code: | 15005-1914 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 724-773-6802 |
Mailing Address - Fax: | 724-770-7919 |
Practice Address - Street 1: | 500 SHARON RD |
Practice Address - Street 2: | |
Practice Address - City: | BEAVER |
Practice Address - State: | PA |
Practice Address - Zip Code: | 15009-1957 |
Practice Address - Country: | US |
Practice Address - Phone: | 724-728-8751 |
Practice Address - Fax: | 724-770-7927 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-27 |
Last Update Date: | 2021-03-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RC0001X | Allopathic & Osteopathic Physicians | Internal Medicine | Clinical Cardiac Electrophysiology | Group - Multi-Specialty |
No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | Group - Multi-Specialty |
No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | Group - Multi-Specialty |
No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
No | 207RR0500X | Allopathic & Osteopathic Physicians | Internal Medicine | Rheumatology | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 2086S0129X | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery | Group - Multi-Specialty |
No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty | |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
PA | 0015654460023 | Medicaid | |
OH | 9280534 | Medicare PIN | |
OH | 9280531 | Medicare PIN |