Penncare-J. Edwin Wood Clinic
NPI #1104967918 in Philadelphia, Pennsylvania
Provider Information
- NPI Number
- 1104967918
- Entity Type
- Organization
- Organization Name
- Penncare-J. Edwin Wood Clinic
- Subpart
- Yes (part of a larger organization)
- Parent Organization
- MEDVANTX, INC.
- Primary Specialty
- Non-Pharmacy Dispensing Site
- Enumeration Date
- Feb 12, 2007
- Last Updated
- Dec 4, 2012
Practice Location
- Address
- 700 SPRUCE ST
- Address 2
- 304
- City
- Philadelphia
- State
- Pennsylvania
- ZIP Code
- 19106-4022
- Phone
- (215) 829-3532
Authorized Official
- Name
- KENNY HEINE
- Title
- DIRECTOR OF OPERATIONS
- Phone
- (858) 625-2990
Specialties & Taxonomy Codes
| Specialty |
|---|
| Non-Pharmacy Dispensing Site |
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