Organization
SURPRISE HEALTH CENTER PLLC
Active
Parent organization
MEDVANTX, INC.
Other names
Surprise Health Center
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
14973 W BELL RD, SUITE 100, SURPRISE, AZ 85374-3236
(623) 815-2900
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
4535
AZ
Other
Enumeration date
01/13/2014
Last updated
01/13/2014
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