# MT. TABOR FAMILY MEDICAL GROUP, P.C.

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MEDVANTX, INC.
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1548416944
- **Legal business name:** MEDVANTX, INC.
- **Authorized official:** KENNY HEINE (DIRECTOR OF OPERATIONS)
- **Authorized official phone:** (858) 625-2990

## Contact information

- **Practice address:** 5919 SE BELMONT ST, PORTLAND, OR 97215-1925
- **Practice address phone:** (503) 234-7366
- **Mailing address:** 5810 NANCY RIDGE DR, 100, SAN DIEGO, CA 92121-2834

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | MD12668 | OR | Yes |

## Other

- **Enumeration date:** 08/18/2008
- **Last updated:** 07/02/2010