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NPI Code Detail

MEDICARE: VISIONARY MEDICAL SERVICES PC

MEDICARE: VISIONARY MEDICAL SERVICES PC
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
1207L00000XAnesthesiology Physician
2207PT0002XMedical Toxicology (Emergency Medicine) Physician
3207P00000XEmergency Medicine Physician

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DF8509OTHERRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2700D117150OTHERMIBCBS

General Provider Information

NPI Number : 1538216569
Entity Type Code : Organization
Provider Name (Legal Business Name) : VISIONARY MEDICAL SERVICES PC
Provider Business Mailing Address
First Line : 2536 MOMENTUM PL
Second Line :
City : CHICAGO
State : IL
Zip : 60689-5325
Country : US
Telephone Number : 616-975-1845
Fax Number : 616-285-0846
Provider Business Practice Location Address
First Line : 100 MICHIGAN ST NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-2560
Country : US
Telephone Number : 616-391-1680
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : JOHN THROOP
Credential : MD
Telephone Number : 616-988-8220
Provider Enumeration Date : 01/04/2007
Last Update Date : 09/20/2023

Similar Medicare Providers

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1871277095 — ALEXANDRA RENTZ
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1952023947 — KYLIE RAE MILLER PA-C
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1619926649 — JOANNA J CHILDERS PA-C
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1578414249 — KRISTIN DZIK
Practice Location Address:
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49503-2560
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Practice Fax:

Directions to “VISIONARY MEDICAL SERVICES PC ” Practice Location

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