Organization
PENNCARE - ROYERSFORD MEDICAL ASSOCIATES
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
420 W LINFIELD RD, LIMERICK, PA 19468-4278
(610) 495-2650
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
OS006549L
PA
Other
Enumeration date
02/12/2007
Last updated
08/25/2010
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