1700881851 NPI number — VISIONARY IMAGING LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700881851 NPI number — VISIONARY IMAGING LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISIONARY IMAGING LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1700881851
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6245 LEMAY FERRY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT LOUIS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63129-2805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-354-1088
Provider Business Mailing Address Fax Number:
314-845-5669

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 N KENTUCKY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST PLAINS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65775-2029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-354-1088
Provider Business Practice Location Address Fax Number:
314-631-4491
Provider Enumeration Date:
06/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FRENZ
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
R
Authorized Official Title or Position:
MANAGING MEMBER/OWNER
Authorized Official Telephone Number:
888-275-9737

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DF5867 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: DE0857 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".
  • Identifier: DG3823 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 161149002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 186488601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200063580A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: DF5273 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 509368601 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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