Healthcare Provider Details

I. General information

NPI: 1225330137
Provider Name (Legal Business Name): HERITAGE VALLEY MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2010
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 DUTCH RIDGE RD
BEAVER PA
15009-9727
US

IV. Provider business mailing address

1000 DUTCH RIDGE RD
BEAVER PA
15009-9727
US

V. Phone/Fax

Practice location:
  • Phone: 724-773-6403
  • Fax: 724-770-7943
Mailing address:
  • Phone: 724-773-6403
  • Fax: 724-770-7943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

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