Provider Demographics
NPI:1689793119
Name:VISION HEALTHCARE PROVIDER SERVICES, LLC
Entity Type:Organization
Organization Name:VISION HEALTHCARE PROVIDER SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SERVICES DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:704-644-5331
Mailing Address - Street 1:1101 TYVOLA RD STE 307
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28217-3515
Mailing Address - Country:US
Mailing Address - Phone:704-884-6446
Mailing Address - Fax:
Practice Address - Street 1:1101 TYVOLA RD STE 307
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-3515
Practice Address - Country:US
Practice Address - Phone:704-884-6446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8301550Medicaid