Provider Demographics
NPI:1346652138
Name:VISIONARY DIAGNOSTICS LLC
Entity Type:Organization
Organization Name:VISIONARY DIAGNOSTICS LLC
Other - Org Name:M&F LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:
Authorized Official - Last Name:FREITAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-239-5804
Mailing Address - Street 1:2450 LOUISIANA ST SUITE 400 #511
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77006
Mailing Address - Country:US
Mailing Address - Phone:727-239-5804
Mailing Address - Fax:
Practice Address - Street 1:2450 LOUISIANA ST SUITE 400 #511
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77006
Practice Address - Country:US
Practice Address - Phone:727-239-5804
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty