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General NPI Number Information
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NPI Number | 1174191605
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Entity Type | Organization
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Legal Business Name | VISIONARY VACCINATION & HEALTH SERVICES
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Dates
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Enumeration Date | 06/11/2021
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Last Update Date | 07/23/2021
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Provider Practice Location Address
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Address Line | 2757 PLAZA WAY
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City | SAINT CHARLES
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State | MO
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Zip | 63303-3533
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Country | US
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Telephone | 636-493-0219
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Fax |
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Provider Business Mailing Address
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Address Line | 2757 PLAZA WAY
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City | SAINT CHARLES
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State | MO
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Zip | 63303-3533
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Country | US
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Telephone | 636-493-0219
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIOINS
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Name | MR. KEVIN A HUSS
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Credential |
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Telephone | 636-493-0219
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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