MEDICARE: HERITAGE VALLEY MULTISPECIALTY GROUP, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154962561
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERITAGE VALLEY MULTISPECIALTY GROUP, INC.

Provider Business Mailing Address
First Line	:	6521 STEUBENVILLE PIKE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15205-1005
Country	:	US
Telephone Number	:	724-773-5890
Fax Number	:	724-773-5892

Provider Business Practice Location Address
First Line	:	6521 STEUBENVILLE PIKE
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15205-1005
Country	:	US
Telephone Number	:	724-773-5890
Fax Number	:	724-773-5892

Authorized Official
Title or Position	:	VICE PRESIDENT & CEO
Name	:	BRYAN J RANDALL
Credential	:
Telephone Number	:	412-749-7027

Provider Enumeration Date	:	10/07/2019
Last Update Date	:	10/07/2019

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