Healthcare Provider Details

I. General information

NPI: 1073548145
Provider Name (Legal Business Name): TRI-STATE ORTHOPAEDICS & SPORTS MEDICINE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 02/12/2021
Certification Date: 02/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 CORPORATE DR SUITE 200
PITTSBURGH PA
15237-7005
US

IV. Provider business mailing address

5900 CORPORATE DR SUITE 200
PITTSBURGH PA
15237-7005
US

V. Phone/Fax

Practice location:
  • Phone: 412-369-4000
  • Fax: 412-369-7667
Mailing address:
  • Phone: 412-369-4000
  • Fax: 412-369-7667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: VICTOR J. THOMAS
Title or Position: MANAGING PHYSICIAN
Credential:
Phone: 412-369-4000