Organization
KNIGHTDALE FAMILY PRACTICE
Active
Parent organization
MEDVANTX, INC.
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
6905 KNIGHTDALE BLVD, SUITE 106, KNIGHTDALE, NC 27545-6505
(919) 266-6211
Mailing address
5810 NANCY RIDGE DR, 100, SAN DIEGO, CA 92121-2834
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
9401111
NC
Other
Enumeration date
07/15/2009
Last updated
07/15/2009
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