Organization
NORTHER LANCASTER COUNTY MEDICAL GROUP
Active
Parent organization
MEDVANTX, INC.
Other names
Wellspan Family Medicine - Crossroads
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
4131 OREGON PIKE, BROWNSTOWN, PA 17508-5083
(717) 859-1123
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
OS004463L
PA
Other
Enumeration date
11/16/2007
Last updated
03/31/2015
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