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NPI Code Detail

MEDICARE: HERITAGE VALLEY MEDICAL GROUP, INC

MEDICARE: HERITAGE VALLEY MEDICAL 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
1207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1285886861
Entity Type Code : Organization
Provider Name (Legal Business Name) : HERITAGE VALLEY MEDICAL GROUP, INC
Provider Business Mailing Address
First Line : 300 PENN LINCOLN DR
Second Line :
City : IMPERIAL
State : PA
Zip : 15126-9772
Country : US
Telephone Number : 724-695-2411
Fax Number :
Provider Business Practice Location Address
First Line : 300 PENN LINCOLN DR
Second Line :
City : IMPERIAL
State : PA
Zip : 15126-9772
Country : US
Telephone Number : 724-695-2411
Fax Number :
Authorized Official
Title or Position : PRESIDENT & CEO
Name : NORMAN F. MITRY
Credential :
Telephone Number : 724-773-4776
Provider Enumeration Date : 10/15/2008
Last Update Date : 06/29/2012

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Directions to “HERITAGE VALLEY MEDICAL GROUP, INC ” Practice Location

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