Organization
BROAD STREET FAMILY HEALTH CENTER
Active
Parent organization
MEDVANTX, INC.
Other names
SPSI - Broad Street Family Health Center
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
211 BROAD ST, MARYSVILLE, PA 17053-1302
(717) 957-3500
Mailing address
9276 SCRANTON RD, SUITE 100, SAN DIEGO, CA 92121-7701
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
OS010593L
PA
Other
Enumeration date
09/04/2008
Last updated
12/17/2015
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