Provider Demographics
NPI:1386279990
Name:MEDIVITA HEALTH
Entity type:Organization
Organization Name:MEDIVITA HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO, PROVIDER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SYLVIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCMAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:361-947-3601
Mailing Address - Street 1:5833 SPOHN DR STE 101B
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-4136
Mailing Address - Country:US
Mailing Address - Phone:361-462-8080
Mailing Address - Fax:
Practice Address - Street 1:5833 SPOHN DR STE 101B
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-4136
Practice Address - Country:US
Practice Address - Phone:361-462-8080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty