Healthcare Provider Details

I. General information

NPI: 1245195817
Provider Name (Legal Business Name): VAULT ADMIN SERVICES, LLC - PRIOR AUTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4022 E GREENWAY RD STE 11-12
PHOENIX AZ
85032-4797
US

IV. Provider business mailing address

4022 E GREENWAY RD STE 11-12
PHOENIX AZ
85032-4797
US

V. Phone/Fax

Practice location:
  • Phone: 309-826-2765
  • Fax:
Mailing address:
  • Phone: 309-826-2765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: JESSICA KESSINGER
Title or Position: GENERAL COUNSEL
Credential:
Phone: 309-826-2765