Organization
PENNCARE-J. EDWIN WOOD CLINIC
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
700 SPRUCE ST, 304, PHILADELPHIA, PA 19106-4022
(215) 829-3532
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
OS012672
PA
Other
Enumeration date
02/12/2007
Last updated
12/04/2012
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