Organization
MEDICAL GROUP OF WINDBER INC
Active
Parent organization
MEDVANTX, INC.
Other names
Medical Group of Windber - Richland
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC.
Authorized official
KENNY HEINE (SR. DIRECTOR OF OPERATIONS)
(858) 625-2990
Entity
Organization
Contact information
Practice address
1511 SCALP AVE, JOHNSTOWN, PA 15904-3315
(814) 269-3667
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
MD025803E
PA
Other
Enumeration date
03/05/2010
Last updated
10/23/2012
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