MEDICARE: VISIONARY IMAGING LLC

Medicare Provider Information

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician		MO

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DF5867	OTHER	MO	MEDICARE RAILROAD
2	DE0857	OTHER	OK	MEDICARE RAILROAD
3	DG3823	OTHER	TX	MEDICARE RAILROAD
7	DF5273	OTHER	IL	MEDICARE RAILROAD

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1700881851
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISIONARY IMAGING LLC

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

Provider Business Practice Location Address
First Line	:	1100 N KENTUCKY AVE
Second Line	:
City	:	WEST PLAINS
State	:	MO
Zip	:	65775-2029
Country	:	US
Telephone Number	:	800-354-1088
Fax Number	:	314-631-4491

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/21/2022

2101 E JEFFERSON ST PPQA MEDICARE COMPLIANCE UNT 6 WEST , KAISER PERMANENTE MID ATLANTIC PERMANENTE MEDICAL GROUP
ROCKVILLE, MD
20852-4908

Practice Phone: 301-816-6660
Practice Fax: 301-816-6308