MEDICARE: TRI-STATE ORTHOPAEDICS & SPORTS MEDICINE, 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	207X00000X	Orthopaedic Surgery Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	C20107	OTHER	PA	RR MEDICARE PIN
3	139618	OTHER	PA	MEDICARE PIN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	139618	OTHER	PA	BLUE SHIELD PIN

General Provider Information

NPI Number	:	1174568232
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRI-STATE ORTHOPAEDICS & SPORTS MEDICINE, INC.

Provider Business Mailing Address
First Line	:	5900 CORPORATE DR
Second Line	:	SUITE 200
City	:	PITTSBURGH
State	:	PA
Zip	:	15237-7005
Country	:	US
Telephone Number	:	412-369-4000
Fax Number	:	412-369-7667

Provider Business Practice Location Address
First Line	:	5900 CORPORATE DR
Second Line	:	SUITE 200
City	:	PITTSBURGH
State	:	PA
Zip	:	15237-7005
Country	:	US
Telephone Number	:	412-369-4000
Fax Number	:	412-369-7667

Authorized Official
Title or Position	:	MANAGING PHYSICIAN
Name	:	DR. VICTOR J THOMAS
Credential	:	MD
Telephone Number	:	412-369-4000

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	02/12/2021

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Directions to “TRI-STATE ORTHOPAEDICS & SPORTS MEDICINE, INC. ” Practice Location

Language	Start Address	Practice Location

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