Organization
LAKESHORE FAMILY MEDICINE ASSOCIATES PC
Active
Parent organization
MEDVANTX, INC.
Other names
Lakeshore Family Medicine Derby
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
7060 ERIE RD, SUITE 100, DERBY, NY 14047-9430
(716) 947-0408
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
233142
NY
Other
Enumeration date
02/27/2014
Last updated
02/27/2014
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