Organization
LEGACY CLINIC WOODBURN
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
1002 N BOONES FERRY RD, WOODBURN, OR 97071-9602
(503) 981-9526
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
MD19203
OR
Other
Enumeration date
03/31/2008
Last updated
10/22/2012
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