Healthcare Provider Details

I. General information

NPI: 1396678660
Provider Name (Legal Business Name): VIDA MED, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3246 MONTGOMERY HWY STE 202
DOTHAN AL
36303-2102
US

IV. Provider business mailing address

3246 MONTGOMERY HWY STE 202
DOTHAN AL
36303-2102
US

V. Phone/Fax

Practice location:
  • Phone: 334-446-4626
  • Fax: 334-203-9748
Mailing address:
  • Phone: 334-446-4626
  • Fax: 334-203-9748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JAMIE TORRES
Title or Position: CEO
Credential: APRN
Phone: 334-672-7368