Organization
EASTSIDE MEDICAL CENTER
Active
Parent organization
MEDVANTX, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC.
Authorized official
KENNY HEINE (DIRECTOR OF OPERATIONS)
(858) 625-2990
Entity
Organization
Contact information
Practice address
2625 PARADE ST, ERIE, PA 16504-2809
(814) 452-6383
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
OS004474L
PA
Other
Enumeration date
11/26/2008
Last updated
10/23/2012
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