Organization
RALEIGH DURHAM MEDICAL GROUP PA
Active
Parent organization
MEDVANTX, INC.
Other names
Family Wellness Clinic
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
2076 HIGHWAY 42 WEST, SUITE 230, CLAYTON, NC 27520
(919) 553-5711
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
200400430
NC
Other
Enumeration date
04/16/2013
Last updated
04/16/2013
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