Organization
COASTAL MEDICAL, INC.
Active
Parent organization
MEDVANTX,INC
Other names
Coastal Medical - Wakefield Medical
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX,INC
Authorized official
MR. KENNY HEINE (VP OF OPERATIONS)
(858) 625-2990
Entity
Organization
Contact information
Practice address
70 KENYON AVE, SUITE 321, WAKEFIELD, RI 02879-4239
(401) 783-0084
(401) 782-0005
Mailing address
5626 OBERLIN DR, SUITE 110, SAN DIEGO, CA 92121-1705
(858) 625-2990
(858) 625-2999
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
MD06582
RI
Other
Enumeration date
02/08/2007
Last updated
04/24/2013
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