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NPI Code Detail

MEDICARE: VIDA FAMILY MEDICINE, LLC

MEDICARE: VIDA FAMILY MEDICINE, 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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1063567832
Entity Type Code : Organization
Provider Name (Legal Business Name) : VIDA FAMILY MEDICINE, LLC
Provider Business Mailing Address
First Line : PO BOX 883
Second Line :
City : SALEM
State : OR
Zip : 97308-0883
Country : US
Telephone Number : 503-399-1400
Fax Number : 503-399-1406
Provider Business Practice Location Address
First Line : 374 OWENS ST SE STE 100
Second Line :
City : SALEM
State : OR
Zip : 97302-4183
Country : US
Telephone Number : 503-399-1400
Fax Number : 503-399-1406
Authorized Official
Title or Position : ADMINISTRATOR
Name : TERI L LITKE-FETSCH
Credential :
Telephone Number : 503-399-1400
Provider Enumeration Date : 01/24/2007
Last Update Date : 04/11/2022

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Directions to “VIDA FAMILY MEDICINE, LLC ” Practice Location

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