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Fayette Physician Network Inc — NPI 1245623453, Grindstone, PA | NPI Central

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NPI 1245623453

OrganizationActive

Fayette Physician Network Inc

NPI 1245623453 · Non-Pharmacy Dispensing Site · Grindstone, PA

Provider details

NPI number: 1245623453
Entity type: Organization
Primary specialty: Non-Pharmacy Dispensing SiteSuppliers
Parent organization: Medvantx, Inc.
Organization subpart: Yes
Authorized official: Kenny Heine, Vp of Operation(858) 964-1506
License: OS016147 (PA)

Specialties & taxonomies

Non-Pharmacy Dispensing SitePrimary332900000XLicense OS016147 (PA)
Suppliers

Practice location

111b Roberts Rd

Grindstone, PA 15442-1105

Phone: (724) 785-3187

Approximate (ZIP-level) locationGet directions

More PA providers

Mailing address

5626 Oberlin Dr

San Diego, CA 92121-1705

Other names (DBA / former)

Doing business as: Fayette Physician Network- Brownsville

Registry dates

Enumerated: 2015-03-12
Last updated: 2015-03-12

Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.