1235310699 NPI number — VISIONQUEST INDUSTRIES, INC.

Table of content: (NPI 1235310699)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235310699 NPI number — VISIONQUEST INDUSTRIES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VISIONQUEST INDUSTRIES, INC.
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:
VQ ORTHOCARE
Provider Other Organization Name Type Code:
3
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:
1235310699
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1390 DECISION ST STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VISTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92081-8578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-266-6969
Provider Business Mailing Address Fax Number:
888-266-6968

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1390 DECISION ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92081-8578
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-261-3000
Provider Business Practice Location Address Fax Number:
888-266-6968
Provider Enumeration Date:
11/14/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HUFF
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
ROY
Authorized Official Title or Position:
VICE PRESIDENT REIMBURSEMENT
Authorized Official Telephone Number:
949-794-3440

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  101923 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 335E00000X , with the licence number: 101923 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 9000158087 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 24886858 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: DM1594 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 10026689800 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".