Organization
WAKE HEALTH SERVICES
Active
Parent organization
MEDVANTX, INC.
Other names
Rock Quarry Road Family Medicine
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC.
Authorized official
KENNY HEINE (DIRECTOR OF OPERATIONS)
(858) 625-2990
Entity
Organization
Contact information
Practice address
1001 ROCK QUARRY RD, RALEIGH, NC 27610-3825
(919) 755-5071
Mailing address
5810 NANCY RIDGE DR, 100, SAN DIEGO, CA 92121-2834
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
200301233
NC
Other
Enumeration date
01/12/2009
Last updated
01/12/2009
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