Organization
PRIME MEDICAL GROUP
Active
Parent organization
MEDVANTX, INC.
Other names
Prime Medical Group - Jefferson
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
1200 BROOKS LN, 110, CLAIRTON, PA 15025-3747
(412) 466-5502
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
OS015942
PA
Other
Enumeration date
06/11/2010
Last updated
07/01/2013
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