Provider Demographics
NPI:1730667247
Name:VISIONS MEDICAL HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:VISIONS MEDICAL HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:TAMIEKA
Authorized Official - Middle Name:LATRELL
Authorized Official - Last Name:ALSTON-GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:864-358-9278
Mailing Address - Street 1:551 BRANCH WOOD DR
Mailing Address - Street 2:
Mailing Address - City:BOILING SPRINGS
Mailing Address - State:SC
Mailing Address - Zip Code:29316-4838
Mailing Address - Country:US
Mailing Address - Phone:864-358-9278
Mailing Address - Fax:631-419-8036
Practice Address - Street 1:169 HALL ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1523
Practice Address - Country:US
Practice Address - Phone:864-358-9278
Practice Address - Fax:864-751-5352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-06
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP2300X
SC19703363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3545Medicaid
NC1902273808Medicaid