MEDICARE: VISIONARY VACCINATION & HEALTH SERVICES

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1174191605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VISIONARY VACCINATION & HEALTH SERVICES

Provider Business Mailing Address
First Line	:	2757 PLAZA WAY
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-3533
Country	:	US
Telephone Number	:	636-493-0219
Fax Number	:

Provider Business Practice Location Address
First Line	:	2757 PLAZA WAY
Second Line	:
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-3533
Country	:	US
Telephone Number	:	636-493-0219
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIOINS
Name	:	MR. KEVIN A HUSS
Credential	:
Telephone Number	:	636-493-0219

Provider Enumeration Date	:	06/11/2021
Last Update Date	:	07/23/2021

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