# TRI-STATE MEDICAL GROUP, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Heritage Valley Rehabilitation Medicine Beaver
- **Organization subpart:** No

## Provider details

- **NPI number:** 1790019438
- **Authorized official:** NORMAN F MITRY (PRESIDENT & CEO)
- **Authorized official phone:** (724) 773-4776

## Contact information

- **Practice address:** 1030 BEANER HOLLOW ROAD, BEAVER MEDICAL COMMONS, BEAVER, PA 15009
- **Practice address phone:** (724) 770-0410
- **Practice address fax:** (724) 770-0414
- **Mailing address:** 1030 BEANER HOLLOW ROAD, BEAVER MEDICAL COMMONS, BEAVER, PA 15009
- **Mailing address phone:** (724) 770-0410
- **Mailing address fax:** (724) 770-0414

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | MD432785 | PA | Yes |

## Other

- **Enumeration date:** 09/29/2009
- **Last updated:** 09/29/2009