Provider Demographics
NPI:1679725279
Name:HERITAGE VALLEY MULTISPECIALTY GROUP, INC.
Entity Type:Organization
Organization Name:HERITAGE VALLEY MULTISPECIALTY GROUP, INC.
Other - Org Name:HVMG MONACA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
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 1:79 WAGNER RD STE 202
Mailing Address - Street 2:
Mailing Address - City:MONACA
Mailing Address - State:PA
Mailing Address - Zip Code:15061-2338
Mailing Address - Country:US
Mailing Address - Phone:724-775-5833
Mailing Address - Fax:724-770-7970
Practice Address - Street 1:79 WAGNER RD STE 202
Practice Address - Street 2:
Practice Address - City:MONACA
Practice Address - State:PA
Practice Address - Zip Code:15061-2338
Practice Address - Country:US
Practice Address - Phone:724-775-5833
Practice Address - Fax:724-770-7970
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HERITAGE VALLEY MULTISPECIALTY GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-15
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0015654460023Medicaid
OH0202677Medicaid
PA807864Medicare PIN