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Heritage Valley Medical Group, Inc.

Organization Active NPI Family Medicine Physician · MC Kees Rocks, PA

NPI 1003477720 · NPPES record last updated Jun 24, 2019

Key facts

NPI
1003477720
Entity type
Organization (NPI type 2)
Primary specialty
Family Medicine Physician 207Q00000X
Legal business name
HERITAGE VALLEY MEDICAL GROUP, INC.
Practice address
596 Pine Hollow Rd
MC Kees Rocks, PA 15136-1661
Phone
(412) 771-6003
Fax
(412) 771-3575
NPI assigned
Jun 24, 2019
Organization subpart
Yes
Parent organization (as reported)
HERITAGE VALLEY MEDICAL GROUP, INC.

Authorized official

Name
Bryan J Randall
Title
Vice President & Cfo
Phone
(412) 749-7027

Corporate family (same tax ID) 13

Organizations that report the same tax identification number in the National Provider Directory.

National Provider Directory

Tax ID family
Tri - State Medical Group Inc (92 organizations share this tax ID)
Part of
Tri - State Medical Group Inc

Locations

596 Pine Hollow Rd
Mc Kees Rocks, PA 15136
Phone (412) 679-7050

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician
Group: 193200000X MULTI-SPECIALTY GROUP		 207Q00000X Yes

Addresses

Primary practice location

596 Pine Hollow Rd
MC Kees Rocks, PA 15136-1661

Mailing address

596 Pine Hollow Rd
MC Kees Rocks, PA 15136-1661
Phone (412) 771-6003

Other identifiers

IdentifierTypeStateIssuer
001565446MedicaidPA

Other names

  • HVMG Primary Care - Pine Hollow Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 24, 2019.

{
    "created_epoch": "1561334400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1561334400000",
    "number": "1003477720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "596 PINE HOLLOW RD",
            "city": "MC KEES ROCKS",
            "state": "PA",
            "postal_code": "151361661",
            "telephone_number": "412-771-6003",
            "fax_number": "412-771-3575"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "596 PINE HOLLOW RD",
            "city": "MC KEES ROCKS",
            "state": "PA",
            "postal_code": "151361661",
            "telephone_number": "412-771-6003",
            "fax_number": "412-771-3575"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HERITAGE VALLEY MEDICAL GROUP, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "HERITAGE VALLEY MEDICAL GROUP, INC.",
        "enumeration_date": "2019-06-24",
        "last_updated": "2019-06-24",
        "status": "A",
        "authorized_official_last_name": "RANDALL",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "VICE PRESIDENT & CFO",
        "authorized_official_telephone_number": "412-749-7027"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001565446",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HVMG Primary Care - Pine Hollow",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in MC Kees Rocks, PA

All providers in MC Kees Rocks, PA · Family Medicine Physician in Pennsylvania

Sources for this page

Verify at the official NPI Registry.