Organization
FAMILY MEDICINE ASSOCIATES OF ITHACA
Active
Parent organization
MEDVANTX, INC.
Other names
Family Medicine Associates State St
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC.
Authorized official
KENNY HEINE (VP OF OPERATIONS)
(858) 964-1506
Entity
Organization
Contact information
Practice address
209 W STATE ST, ITHACA, NY 14850-5429
(607) 277-4341
Mailing address
5626 OBERLIN DR, SUITE 110, SAN DIEGO, CA 92121-1705
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
143456
NY
Other
Enumeration date
07/18/2014
Last updated
07/21/2014
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