Organization
UPMC COMMUNITY MEDCINE INC
Active
Parent organization
MEDVANTX, INC.
Other names
Lakeside Family Medicine Andover
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
149 E MAIN ST, ANDOVER, OH 44003-9479
(440) 293-5555
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
34.004448
OH
Other
Enumeration date
08/19/2014
Last updated
08/19/2014
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