MEDICARE: VIDALIA HEALTH SERVICES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QR0200X	Radiology Clinic/Center

General Provider Information

NPI Number	:	1699600874
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIDALIA HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	1707 MEADOWS LN STE B
Second Line	:
City	:	VIDALIA
State	:	GA
Zip	:	30474-7201
Country	:	US
Telephone Number	:	912-535-7100
Fax Number	:

Provider Business Practice Location Address
First Line	:	1707 MEADOWS LN STE B
Second Line	:
City	:	VIDALIA
State	:	GA
Zip	:	30474-7201
Country	:	US
Telephone Number	:	912-535-7100
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	JARED KIRBY
Credential	:
Telephone Number	:	912-535-7100

Provider Enumeration Date	:	06/17/2026
Last Update Date	:	06/17/2026

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Directions to “VIDALIA HEALTH SERVICES, LLC ” Practice Location

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