# ATLANTICARE PHYSICIAN GROUP PA

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MEDVANTX, INC.
- **Other names:** AtlantiCare Urgent Care - Marmora
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1578919460
- **Legal business name:** MEDVANTX, INC.
- **Authorized official:** KENNY HEINE (VP OF OPERATIONS)
- **Authorized official phone:** (858) 964-1506

## Contact information

- **Practice address:** 210 S SHORE RD, SUITE 201, MARMORA, NJ 08223-1200
- **Practice address phone:** (609) 390-3820
- **Mailing address:** 9276 SCRANTON RD, SUITE 100, SAN DIEGO, CA 92121-7701

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | 25MB04695400 | NJ | Yes |

## Other

- **Enumeration date:** 05/10/2016
- **Last updated:** 05/10/2016