Organization
BLACKSHEEP MEDICAL LLC
Active
Organization
BLACKSHEEP MEDICAL LLC
Active
Parent organization
MEDVANTX, INC.
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
1425 HAND AVE, SUITE L, ORMOND BEACH, FL 32174-1135
(386) 256-3977
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
OS8215
FL
Other
Enumeration date
11/02/2013
Last updated
11/02/2013
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