Provider Demographics
NPI:1598073033
Name:VISIONARY ENTERPRISES INC
Entity Type:Organization
Organization Name:VISIONARY ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-621-7409
Mailing Address - Street 1:6626 E 75TH ST STE 200
Mailing Address - Street 2:ATTN L PENDLETON
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2855
Mailing Address - Country:US
Mailing Address - Phone:317-621-7543
Mailing Address - Fax:317-621-7163
Practice Address - Street 1:1400 N RITTER AVE STE 145
Practice Address - Street 2:FIGLEAF BOUTIQUE CHE
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3052
Practice Address - Country:US
Practice Address - Phone:317-355-3441
Practice Address - Fax:317-351-2423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-17
Last Update Date:2019-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000718169OtherANTHEM
IN201011720AMedicaid
IN201011720AMedicaid