Provider Demographics
NPI:1245300680
Name:VIP HEALTHCARE PROFESSIONALS, LLC
Entity type:Organization
Organization Name:VIP HEALTHCARE PROFESSIONALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:VEEDA
Authorized Official - Middle Name:LAVON
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-235-2273
Mailing Address - Street 1:2600 WEST BLVD
Mailing Address - Street 2:COLONIAL SQUARE OFFICE PARK
Mailing Address - City:BELLEVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62221-5605
Mailing Address - Country:US
Mailing Address - Phone:618-235-2273
Mailing Address - Fax:618-235-2417
Practice Address - Street 1:2600 WEST BLVD
Practice Address - Street 2:COLONIAL SQUARE OFFICE PARK
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62221-5605
Practice Address - Country:US
Practice Address - Phone:618-235-2273
Practice Address - Fax:618-235-2417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
IL147980Medicare Oscar/Certification