Healthcare Provider Details

I. General information

NPI: 1245097922
Provider Name (Legal Business Name): MEDVIDI HEALTH PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2024
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S MCDOWELL ST # 125-2098
CHARLOTTE NC
28204-2623
US

IV. Provider business mailing address

4010 MOORPARK AVE STE 114
SAN JOSE CA
95117-1804
US

V. Phone/Fax

Practice location:
  • Phone: 504-414-5095
  • Fax:
Mailing address:
  • Phone: 415-966-0848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LAURA E PURDY
Title or Position: CMO
Credential:
Phone: 910-644-8373