Provider Demographics
NPI:1568135119
Name:VIDAMED LLC
Entity Type:Organization
Organization Name:VIDAMED LLC
Other - Org Name:VIDAMED LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:NIGAGLIONI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:939-638-5050
Mailing Address - Street 1:PO BOX 114
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-0114
Mailing Address - Country:US
Mailing Address - Phone:939-638-5050
Mailing Address - Fax:
Practice Address - Street 1:URB VILLA MILAGROS
Practice Address - Street 2:53 CALLE 25 DE JULIO
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698
Practice Address - Country:US
Practice Address - Phone:939-638-5050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-29
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health