Provider Demographics
NPI:1700881851
Name:VISIONARY IMAGING LLC
Entity Type:Organization
Organization Name:VISIONARY IMAGING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:FRENZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-275-9737
Mailing Address - Street 1:6245 LEMAY FERRY RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-2805
Mailing Address - Country:US
Mailing Address - Phone:800-354-1088
Mailing Address - Fax:314-845-5669
Practice Address - Street 1:1100 N KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2029
Practice Address - Country:US
Practice Address - Phone:800-354-1088
Practice Address - Fax:314-631-4491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MODF5867OtherMEDICARE RAILROAD
OKDE0857OtherMEDICARE RAILROAD
TXDG3823OtherMEDICARE RAILROAD
AR161149002Medicaid
TX186488601Medicaid
OK200063580AMedicaid
ILDF5273OtherMEDICARE RAILROAD
MO509368601Medicaid
OKDE0857OtherMEDICARE RAILROAD
AR161149002Medicaid
IL214527Medicare PIN
TXDG3823OtherMEDICARE RAILROAD
MODF5867OtherMEDICARE RAILROAD
TX186488601Medicaid
KSR820000Medicare PIN
WV9372191Medicare UPIN