Healthcare Provider Details

I. General information

NPI: 1073089918
Provider Name (Legal Business Name): HERITAGE VALLEY MULTISPECIALTY GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2018
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 BEANER HOLLOW RD
BEAVER PA
15009-9723
US

IV. Provider business mailing address

2 PEARTREE WAY
BEAVER PA
15009-1954
US

V. Phone/Fax

Practice location:
  • Phone: 724-775-4242
  • Fax:
Mailing address:
  • Phone: 724-773-6802
  • Fax: 724-770-7919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

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