Organization
CENTRACARE CLINIC - LONG PRAIRIE
Active
Organization
CENTRACARE CLINIC - LONG PRAIRIE
Active
Parent organization
MEDVANTX, INC.
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
24 9TH ST SE, LONG PRAIRIE, MN 56347-1404
(320) 732-2131
Mailing address
9276 SCRANTON RD, SUITE 100, SAN DIEGO, CA 92121-7701
(858) 625-2990
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
36275
MN
Other
Enumeration date
05/01/2008
Last updated
12/02/2015
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