Organization Active NPI

Visionary Vaccination & Health Services

  • Clinic/Center
  • Saint Charles, MO
National Provider Identifier
1174191605
Registry record updated Jul 23, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
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

Updated by the provider on Jul 23, 2021

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)CodeLicenseStatePrimary
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 IDStateProvider typePAC IDDetails
O20210927002174 MO Part B Supplier - Mass Immunization (Roster Biller Only) 5698172112 Practice locations: Saint Charles, MO

National Provider Directory

National Provider Directory

Locations

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.

Verify at the official NPI Registry.