Healthcare Provider Details

I. General information

NPI: 1972174233
Provider Name (Legal Business Name): HERITAGE VALLEY MULTISPECIALTY GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2021
Last Update Date: 07/08/2021
Certification Date: 07/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48462 BELL SCHOOL RD STE C
EAST LIVERPOOL OH
43920-9625
US

IV. Provider business mailing address

48462 BELL SCHOOL RD STE C
EAST LIVERPOOL OH
43920-9625
US

V. Phone/Fax

Practice location:
  • Phone: 724-773-4502
  • Fax: 330-385-5980
Mailing address:
  • Phone: 724-773-4502
  • Fax: 330-385-5980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: NORMAN F MITRY
Title or Position: PRESIDENT & CEO
Credential:
Phone: 724-773-4776