Organization
FAMILY HEALTHSERVICES MINNESOTA, P.A.
Active
Parent organization
MEDVANTX, INC.
Other names
FHSM - Gorman Clinic
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
234 WENTWORTH AVE E, WEST ST PAUL, MN 55118-3525
(651) 455-2940
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
23358
MN
Other
Enumeration date
04/16/2009
Last updated
10/23/2012
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