# BEAVER MEDICAL GROUP LP

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MEDVANTX INC
- **Other names:** Beaver Medical Group - Banning Extended Care
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1881857597
- **Legal business name:** MEDVANTX INC
- **Authorized official:** KENNY HEINE (VP OF OPERATIONS)
- **Authorized official phone:** (858) 625-2990

## Contact information

- **Practice address:** 6109 W RAMSEY ST, BANNING, CA 92220-3051
- **Practice address phone:** (951) 845-0313
- **Mailing address:** 5626 OBERLIN DR, SUITE 110, SAN DIEGO, CA 92121-1705

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | C51632 | CA | Yes |

## Other

- **Enumeration date:** 07/03/2008
- **Last updated:** 04/25/2013