Active NPI
Visionary Vaccination & Health Services
- Clinic/Center
- Saint Charles, MO
National Provider Identifier
1174191605
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinic/Center
- Legal business name
- VISIONARY VACCINATION & HEALTH SERVICES
- Practice address
- 2757 Plaza Way
Saint Charles, MO 63303-3533 - Phone
- (636) 493-0219
- NPI assigned
- Jun 11, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Kevin A Huss
- Title
- Director of Operatioins
- Phone
- (636) 493-0219
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinic/Center | 261Q00000X | Primary |
Addresses
Primary practice location
2757 Plaza Way
Saint Charles, MO 63303-3533
Mailing address
2757 Plaza Way
Saint Charles, MO 63303-3533
Phone (636) 493-0219
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20210927002174 | MO | Part B Supplier - Mass Immunization (Roster Biller Only) | 5698172112 | Practice locations: Saint Charles, MO |
National Provider Directory
National Provider DirectoryLocations
2757 Plaza Way
Saint Charles, MO 63303
Phone (636) 493-0219
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623369600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1626998400000",
"number": "1174191605",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2757 PLAZA WAY",
"city": "SAINT CHARLES",
"state": "MO",
"postal_code": "633033533",
"telephone_number": "636-493-0219"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2757 PLAZA WAY",
"city": "SAINT CHARLES",
"state": "MO",
"postal_code": "633033533",
"telephone_number": "636-493-0219"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "VISIONARY VACCINATION & HEALTH SERVICES",
"organizational_subpart": "NO",
"enumeration_date": "2021-06-11",
"last_updated": "2021-07-23",
"certification_date": "2021-07-23",
"status": "A",
"authorized_official_last_name": "HUSS",
"authorized_official_first_name": "KEVIN",
"authorized_official_middle_name": "A",
"authorized_official_title_or_position": "DIRECTOR OF OPERATIOINS",
"authorized_official_telephone_number": "636-493-0219",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "261Q00000X",
"taxonomy_group": "",
"desc": "Clinic/Center",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Saint Charles, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.