Organization
ATLANTICARE PHYSICIAN GROUP PA
Active
Parent organization
MEDVANTX, INC.
Other names
AtlantiCare Urgent Care - Clementon
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
1310 BLACKWOOD CLEMENTON RD, CLEMENTON, NJ 08021-5610
(865) 783-1802
Mailing address
9276 SCRANTON RD, SUITE 100, SAN DIEGO, CA 92121-7701
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
25MA08229800
NJ
Other
Enumeration date
04/19/2016
Last updated
04/19/2016
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