Organization
TRI - STATE MEDICAL GROUP, INC.
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
21 7TH ST, MIDLAND, PA 15059-1452
(724) 643-4852
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
OS006001L
PA
Other
Enumeration date
02/09/2007
Last updated
10/17/2012
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