OrganizationActive
Penncare-J. Edwin Wood Clinic
NPI 1104967918 · Non-Pharmacy Dispensing Site · Philadelphia, PA
Penncare-J. Edwin Wood Clinic is a Non-Pharmacy Dispensing Site organization in Philadelphia, PA (NPI 1104967918).
Provider details
- NPI number
- 1104967918
- Entity type
- Organization
- Primary specialty
- Non-Pharmacy Dispensing SiteSuppliers
- Parent organization
- Medvantx, Inc.
- Organization subpart
- Yes
- Authorized official
- Kenny Heine, Director of Operations(858) 625-2990
- License
- OS012672 (PA)
Specialties & taxonomies
Suppliers
Profile Score
Detailed profile(90/100 index)
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
19 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
Practice location
700 Spruce St
304
Philadelphia, PA 19106-4022
Phone: (215) 829-3532
Street-level locationGet directions
Mailing address
5626 Oberlin Dr
San Diego, CA 92121-1705
Registry dates
- Enumerated
- 2007-02-12
- Last updated
- 2012-12-04
Frequently asked questions
- What is Penncare-J. Edwin Wood Clinic's NPI number?
- Penncare-J. Edwin Wood Clinic's National Provider Identifier (NPI) is 1104967918, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Penncare-J. Edwin Wood Clinic?
- Penncare-J. Edwin Wood Clinic is classified in the NPPES registry as Non-Pharmacy Dispensing Site (Suppliers).
- Where is Penncare-J. Edwin Wood Clinic located?
- Penncare-J. Edwin Wood Clinic's practice location on file with NPPES is 700 Spruce St, Philadelphia, PA 19106-4022.
- What is Penncare-J. Edwin Wood Clinic's phone number?
- The practice phone number listed in the NPPES registry for Penncare-J. Edwin Wood Clinic is (215) 829-3532.
- Who is the authorized official for Penncare-J. Edwin Wood Clinic?
- The authorized official listed on Penncare-J. Edwin Wood Clinic's NPPES record is Kenny Heine, Director of Operations. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Penncare-J. Edwin Wood Clinic's NPI active?
- Yes — Penncare-J. Edwin Wood Clinic's NPI (1104967918) is active in the NPPES registry as of the last update on 2012-12-04.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.