Organization
BEAVER MEDICAL GROUP LP
Active
Parent organization
MEDVANTX, INC.
Other names
Beaver Medical Group Highland Springs
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
81 HIGHLAND SPRINGS AVE, SUITE 200, BEAUMONT, CA 92223-3170
(951) 845-0313
Mailing address
9276 SCRANTON RD, SUITE 100, SAN DIEGO, CA 92121-7701
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
A52212
CA
Other
Enumeration date
06/18/2014
Last updated
01/08/2016
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