Organization
COASTAL MEDICAL, INC.
Active
Organization
COASTAL MEDICAL, INC.
Active
Parent organization
MEDVANTX, INC
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
450 VETERANS MEMORIAL PKWY, 404, EAST PROVIDENCE, RI 02914-5300
(401) 435-3400
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
MD12072
RI
Other
Enumeration date
06/27/2007
Last updated
01/26/2015
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