Organization
COASTAL MEDICAL, INC.
Active
Organization
COASTAL MEDICAL, INC.
Active
Parent organization
MEDVANTX, INC
Other names
Coastal Medical - Elmhurst
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC
Authorized official
KENNY HEINE (VP OF OPERATIONS)
(858) 625-2990
Entity
Organization
Contact information
Practice address
1075 SMITH ST, 2ND FLOOR, PROVIDENCE, RI 02908-2700
(401) 421-4400
Mailing address
5626 OBERLIN DR, SUITE 110, SAN DIEGO, CA 92121-1705
(858) 625-2990
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
MD08852
RI
Other
Enumeration date
06/27/2007
Last updated
10/24/2013
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