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General NPI Number Information
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NPI Number | 1942366083
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Entity Type | Organization
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Legal Business Name | VISTA HEALTH PLAN, INC.
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Dates
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Enumeration Date | 12/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1701 E 7TH ST
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City | AUSTIN
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State | TX
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Zip | 78702-2712
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Country | US
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Telephone | 512-433-1171
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Fax |
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Provider Business Mailing Address
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Address Line | 1701 E 7TH ST
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City | AUSTIN
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State | TX
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Zip | 78702-2712
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Country | US
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Telephone | 512-433-1171
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Fax |
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Authorized Official
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Title or Position | VICE-PRESIDENT
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Name | MS. JANET I. MONTEROS
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Credential | J.D.
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Telephone | 512-433-1171
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 94390
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License Number State | TX
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