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Contact Information

TRI-STATE MEDICAL GROUP, INC.
ROUTE 18 WAL-MART SHOPPING PLAZA
HERITAGE VALLEY CONVENIENT CARE-MONACA
MONACA, PA15061
 Phone: 724-774-5175
 Fax: 724-774-5175
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine

207Q00000X 08 Physician/Family Practice
 

Internal Medicine

207R00000X 11 Physician/Internal Medicine
 

Medical

363AM0700X 97 Physician Assistant
 

Nurse Practitioner

363L00000X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for TRI-STATE MEDICAL GROUP, INC.

NPI # 1326275595
LBN Legal business name TRI-STATE MEDICAL GROUP, INC.
Authorized official NORMAN MITRY - (PRESIDENT & CEO)
Entity Organization
Organization subpart 1 No
Enumeration date 06/16/2009
Last updated 06/16/2009 - About 17 years ago
Identifiers
PA Medicaid 0014950830029
PA Medicaid 0015654460023
PA Medicaid 1007289980010
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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