1598797094 NPI number — SLH VISTA, INC.

Table of content: (NPI 1598797094)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598797094 NPI number — SLH VISTA, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SLH VISTA, 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:
Provider Other Organization Name Type Code:
6
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:
1598797094
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 741286
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATLANTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30374-1286
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-242-2002
Provider Business Mailing Address Fax Number:
314-577-8003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3635 VISTA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63110-2539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-577-8000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ARMIN
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
VP OF GOVT PROGRAMS, TENET
Authorized Official Telephone Number:
818-436-2267

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 441-7 , 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: 154661601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3284 . This is a "COVENTRY HEALTH CARE GROU" identifier . This identifiers is of the category "OTHER".
  • Identifier: 000443 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 171 . This is a "BCBS OF MISSOURI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1748722 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 260105B000000 . This is a "SECTION 1011" identifier . This identifiers is of the category "OTHER".
  • Identifier: 01400704 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180984400 . This is a "DEPT OF LABOR ACS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2600105 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000918629X , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11221A , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 136563105 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1333 . This is a "BCBS OF MISSOURI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2601052 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 010671907 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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