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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