Provider Demographics
NPI:1942366083
Name:VISTA HEALTH PLAN, INC.
Entity Type:Organization
Organization Name:VISTA HEALTH PLAN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:JANET
Authorized Official - Middle Name:I
Authorized Official - Last Name:MONTEROS
Authorized Official - Suffix:
Authorized Official - Credentials:JD
Authorized Official - Phone:512-433-1171
Mailing Address - Street 1:1701 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-2712
Mailing Address - Country:US
Mailing Address - Phone:512-433-1171
Mailing Address - Fax:
Practice Address - Street 1:1701 E 7TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-2712
Practice Address - Country:US
Practice Address - Phone:512-433-1171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX94390302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization