Provider Demographics
NPI:1689621401
Name:HERITAGE VALLEY PEDIATRICS, INC.
Entity Type:Organization
Organization Name:HERITAGE VALLEY PEDIATRICS, INC.
Other - Org Name:TRI STATE PEDIATRIC ASSOCIATES INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:MITRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-773-4779
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 1:250 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2706
Practice Address - Country:US
Practice Address - Phone:724-774-4070
Practice Address - Fax:724-774-2872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007289980001Medicaid
PA1007289980010Medicaid
PA1007289980010Medicaid