Organization
TRI-STATE MEDICAL GROUP, INC.
Active
Other names
Heritage Valley Rehabilitation Medicine Beaver
Organization subpart
No
Provider details
NPI number
Authorized official
NORMAN F MITRY (PRESIDENT & CEO)
(724) 773-4776
Entity
Organization
Contact information
Practice address
1030 BEANER HOLLOW ROAD, BEAVER MEDICAL COMMONS, BEAVER, PA 15009
(724) 770-0410
(724) 770-0414
Mailing address
1030 BEANER HOLLOW ROAD, BEAVER MEDICAL COMMONS, BEAVER, PA 15009
(724) 770-0410
(724) 770-0414
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
MD432785
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0015654460023
—
PA
05
—
0202677
—
OH
Enumeration date
09/29/2009
Last updated
09/29/2009
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