Organization
WILLAMETTE COMMUNITY MEDICAL GROUP, LLC
Active
Parent organization
MEDVANTX, INC.
Other names
OMG Thurston Medical Group
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
5781 MAIN ST, SPRINGFIELD, OR 97478-5426
(541) 284-1694
Mailing address
5810 NANCY RIDGE DR, 100, SAN DIEGO, CA 92121-2834
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
MD15590
OR
Other
Enumeration date
12/18/2008
Last updated
12/18/2008
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