Provider Demographics
NPI:1659987832
Name:VIDA ONCOLOGY LLC
Entity Type:Organization
Organization Name:VIDA ONCOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:AYON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-796-2200
Mailing Address - Street 1:2150 INTELLIPLEX DR STE 134
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46176-8550
Mailing Address - Country:US
Mailing Address - Phone:317-796-2200
Mailing Address - Fax:
Practice Address - Street 1:2150 INTELLIPLEX DR STE 134
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IN
Practice Address - Zip Code:46176-8550
Practice Address - Country:US
Practice Address - Phone:317-796-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-22
Last Update Date:2020-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty