Organization
RALEIGH DURHAM MEDICAL GROUP PA
Active
Parent organization
MEDVANTX, INC.
Other names
Family Wellness Clinic Raleigh
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
8020 CREEDMOOR RD, RALEIGH, NC 27613-4363
(919) 322-2844
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
0010-02907
NC
Other
Enumeration date
04/18/2016
Last updated
04/18/2016
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