Organization
SEWICKLEY VALLEY MEDICAL GROUP, INC.
Active
Organization
SEWICKLEY VALLEY MEDICAL GROUP, INC.
Active
Parent organization
MEDVANTX, INC.
Other names
Sewickley Valley Medical Group - Fifth Avenue
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC.
Authorized official
MR. KENNY HEINE (DIRECTOR OF OPERATIONS)
(858) 625-2990
Entity
Organization
Contact information
Practice address
1101 5TH AVE, CORAOPOLIS, PA 15108-1577
(412) 269-0899
Mailing address
5626 OBERLIN DR, SUITE 110, SAN DIEGO, CA 92121-1705
(858) 625-2990
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
MD033170E
PA
Other
Enumeration date
02/08/2007
Last updated
10/16/2012
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