Provider Demographics
NPI:1275390940
Name:MEDVIDI HEALTH PC
Entity Type:Organization
Organization Name:MEDVIDI HEALTH PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:E
Authorized Official - Last Name:PURDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-644-8373
Mailing Address - Street 1:4010 MOORPARK AVE STE 114
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-1804
Mailing Address - Country:US
Mailing Address - Phone:415-966-0848
Mailing Address - Fax:
Practice Address - Street 1:230 E OHIO ST # 410-1155
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3265
Practice Address - Country:US
Practice Address - Phone:504-414-5095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health