Provider Demographics
NPI:1073198065
Name:VISIONARY CTS LLC
Entity Type:Organization
Organization Name:VISIONARY CTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BREEDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:913-669-9394
Mailing Address - Street 1:1551 WALL ST STE 120
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-3540
Mailing Address - Country:US
Mailing Address - Phone:636-219-0177
Mailing Address - Fax:636-493-1002
Practice Address - Street 1:1551 WALL ST STE 120
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-3540
Practice Address - Country:US
Practice Address - Phone:636-219-0177
Practice Address - Fax:636-493-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-11
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center