Organization
WESTERN WAKE INTERNAL MEDICINE
Active
Parent organization
MEDVANTX, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC.
Authorized official
KENNY HEINE (SR DIRECTOR OPERATIONS)
(858) 625-2990
Entity
Organization
Contact information
Practice address
907 KILDAIRE FARM RD, CARY, NC 27511-3922
(919) 319-6610
Mailing address
5810 NANCY RIDGE DR, 100, SAN DIEGO, CA 92121-2834
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
9801744
NC
Other
Enumeration date
07/06/2010
Last updated
07/06/2010
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