MEDICARE: MEDVIDI HEALTH PC

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	2084P0800X	Psychiatry Physician

General Provider Information

NPI Number	:	1275382863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDVIDI HEALTH PC

Provider Business Mailing Address
First Line	:	4010 MOORPARK AVE STE 114
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95117-1804
Country	:	US
Telephone Number	:	415-966-0848
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 E COSTILLA ST
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-2106
Country	:	US
Telephone Number	:	504-414-5095
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	LAURA E PURDY
Credential	:
Telephone Number	:	910-644-8373

Provider Enumeration Date	:	05/15/2024
Last Update Date	:	05/15/2024

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Directions to “MEDVIDI HEALTH PC ” Practice Location

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