Organization
BLACK RIVER HEALTH SERVICES INC
Active
Parent organization
MEDVANTX, INC.
Other names
Black River Family Practice
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
301 S CAMPBELL ST, BURGAW, NC 28425-5011
(910) 259-5721
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
2006-01488
NC
Other
Enumeration date
08/25/2014
Last updated
08/25/2014
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