Organization
HERITAGE VALLEY MEDICAL GROUP, INC.
Active
Parent organization
TRI-STATE MEDICAL GROUP, INC
Other names
HVMNG Beaver Internal Medicine Associates
Organization subpart
Yes
Provider details
NPI number
Legal business name
TRI-STATE MEDICAL GROUP, INC
Authorized official
NORMAN MITRY (PRESIDENT & CEO)
(724) 773-4776
Entity
Organization
Contact information
Practice address
701 5TH ST, BEAVER, PA 15009-1964
(724) 774-0232
Mailing address
701 5TH ST, BEAVER, PA 15009-1964
(724) 774-0232
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015654460023
—
PA
05
—
0202677
—
OH
Enumeration date
10/15/2008
Last updated
06/29/2012
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