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General NPI Number Information
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NPI Number | 1396678660
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Entity Type | Organization
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Legal Business Name | VIDA MED, LLC
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Dates
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Enumeration Date | 06/05/2026
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Last Update Date | 06/05/2026
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Provider Practice Location Address
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Address Line | 3246 MONTGOMERY HWY STE 202
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City | DOTHAN
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State | AL
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Zip | 36303-2102
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Country | US
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Telephone | 334-446-4626
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Fax | 334-203-9748
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Provider Business Mailing Address
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Address Line | 3246 MONTGOMERY HWY STE 202
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City | DOTHAN
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State | AL
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Zip | 36303-2102
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Country | US
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Telephone | 334-446-4626
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Fax | 334-203-9748
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Authorized Official
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Title or Position | CEO
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Name | JAMIE TORRES
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Credential | APRN
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Telephone | 334-672-7368
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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