Healthcare Provider Details

I. General information

NPI: 1306084801
Provider Name (Legal Business Name): TRI STATE MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 01/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

918 3RD AVE
BEAVER FALLS PA
15010-4613
US

IV. Provider business mailing address

918 3RD AVE
BEAVER FALLS PA
15010-4613
US

V. Phone/Fax

Practice location:
  • Phone: 724-773-8895
  • Fax:
Mailing address:
  • Phone: 724-773-8895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberOS010098L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberOS010098L
License Number StatePA

VIII. Authorized Official

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