Organization
VIDANT MEDICAL GROUP LLC
Active
Organization
VIDANT MEDICAL GROUP LLC
Active
Parent organization
MEDVANTX, INC.
Other names
Vidant Immediate Care Ahoskie
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
226 ACADEMY ST S, AHOSKIE, NC 27910-2451
(252) 209-3911
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
2010-01183
NC
Other
Enumeration date
10/16/2015
Last updated
10/16/2015
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