Provider Demographics
NPI:1225792898
Name:MEDVIDI HEALTH PC
Entity Type:Organization
Organization Name:MEDVIDI HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ED
Authorized Official - Middle Name:J
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-910-9362
Mailing Address - Street 1:1884 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-6227
Mailing Address - Country:US
Mailing Address - Phone:415-554-0171
Mailing Address - Fax:415-449-3540
Practice Address - Street 1:1884 MARKET ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-6227
Practice Address - Country:US
Practice Address - Phone:415-554-0171
Practice Address - Fax:415-449-3540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-28
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1295846822Medicaid
FL1205923216Medicaid
CO1457896128Medicaid