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Organization
TRI-STATE MEDICAL GROUP, INC
Active
Organization
TRI-STATE MEDICAL GROUP, INC
Active
Other names
Convenient Care Center-Beaver
Organization subpart
No
Provider details
NPI number
Authorized official
MR. NORMAN F. MITRY (PRESIDENT & CEO)
(724) 773-4776
Entity
Organization
Contact information
Practice address
274 3RD ST, SUITE 100, BEAVER, PA 15009-2333
(724) 774-2942
(724) 774-2942
Mailing address
274 3RD ST, SUITE 100, BEAVER, PA 15009-2333
(724) 774-2942
(724) 774-2942
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
NULL
207Q00000X
Family Medicine Physician
—
—
207R00000X
Internal Medicine Physician
—
NULL
207R00000X
Internal Medicine Physician
—
—
208000000X
Pediatrics Physician
—
NULL
208000000X
Pediatrics Physician
—
—
363A00000X
Physician Assistant
—
NULL
363A00000X
Physician Assistant
—
—
363AM0700X
Medical Physician Assistant
—
NULL
363AM0700X
Medical Physician Assistant
—
—
363L00000X
Nurse Practitioner
Primary
—
NULL
363L00000X
Nurse Practitioner
Primary
—
—
363LF0000X
Family Nurse Practitioner
—
NULL
363LF0000X
Family Nurse Practitioner
—
—
363LP0200X
Pediatric Nurse Practitioner
—
NULL
363LP0200X
Pediatric Nurse Practitioner
—
—
363LP2300X
Primary Care Nurse Practitioner
—
NULL
363LP2300X
Primary Care Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015486320010
—
PA
05
—
0015654460023
—
PA
05
—
0202677
—
OH
05
—
1007289980010
—
PA
Enumeration date
12/04/2008
Last updated
12/04/2008
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