Doctors Medplus Medical Center

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

G29852 Issued in CA

Legal business name

DOCTORS MEDPLUS MEDICAL CENTER

Practice address

877 Oak Park Blvd
Pismo Beach, CA 93449-3292

Phone

(805) 474-8450

NPI assigned

Jun 9, 2009

Last updated

Jun 9, 2009By the provider in NPPES

Organization subpart

Yes

Parent organization

MEDVANTX, INC.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kenny Heine

Title

Director of Operations

Phone

(858) 625-2990

Specialties & licenses 1

Addresses

Part of

Medvantx Inc

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1244505600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1244505600000",
    "number": "1316173974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5810 NANCY RIDGE DR",
            "address_2": "100",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921212834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "877 OAK PARK BLVD",
            "city": "PISMO BEACH",
            "state": "CA",
            "postal_code": "934493292",
            "telephone_number": "805-474-8450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOCTORS MEDPLUS MEDICAL CENTER",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2009-06-09",
        "last_updated": "2009-06-09",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "CA",
            "license": "G29852",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Non-Pharmacy Dispensing Site in Pismo Beach, CA
• Providers in Pismo Beach, CA by specialty
• Non-Pharmacy Dispensing Site in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.