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Organization

RALEIGH DURHAM MEDICAL GROUP PA

Active
Parent organization
MEDVANTX, INC.
Other names
ROXBORO FAMILY MEDICINE
Organization subpart
Yes

Provider details

NPI number
Legal business name
MEDVANTX, INC.
Authorized official
KENNY HEINE (VP OPS)
(858) 964-1506
Entity
Organization

Contact information

Practice address
107 WEEKS DR, ROXBORO, NC 27573-3933
(336) 598-5480
Mailing address
5626 OBERLIN DR, 110, SAN DIEGO, CA 92121-1705

Taxonomy

Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
104138
NC

Other

Enumeration date
12/17/2012
Last updated
12/17/2012
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