Healthcare Provider Details

I. General information

NPI: 1003068891
Provider Name (Legal Business Name): HERITAGE VALLEY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2008
Last Update Date: 06/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 SHARON RD
BEAVER PA
15009-1919
US

IV. Provider business mailing address

605 SHARON RD
BEAVER PA
15009-1919
US

V. Phone/Fax

Practice location:
  • Phone: 724-728-3320
  • Fax:
Mailing address:
  • Phone: 724-728-3320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number
License Number State
# 2
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