Provider Demographics
NPI:1780653576
Name:VISTA IMAGING PARTNERS
Entity Type:Organization
Organization Name:VISTA IMAGING PARTNERS
Other - Org Name:VISTA IMAGING OF JEFFERSON COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:CECIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-669-6161
Mailing Address - Street 1:1301 YMCA DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-2655
Mailing Address - Country:US
Mailing Address - Phone:636-931-8500
Mailing Address - Fax:636-931-8504
Practice Address - Street 1:1301 YMCA DR
Practice Address - Street 2:SUITE 600
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-2655
Practice Address - Country:US
Practice Address - Phone:636-931-8500
Practice Address - Fax:636-931-8504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)
No261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology