Organization
FAYETTE PHYSICIAN NETWORK INC
Active
Organization
FAYETTE PHYSICIAN NETWORK INC
Active
Parent organization
MEDVANTX, INC.
Other names
Fayette Physician Network-Masontown
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
2175 MCCLELLANDTOWN RD, MASONTOWN, PA 15461-2593
(724) 583-2819
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
MD417327
PA
Other
Enumeration date
03/10/2015
Last updated
03/10/2015
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