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Organization
VISTA PEM PROVIDERS, LLC
Active
Organization
VISTA PEM PROVIDERS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CLERISSA HADLEY (DIRECTOR OF NETWORK DEVELOPMENT)
(972) 215-7410
Entity
Organization
Contact information
Practice address
5072 W PLANO PKWY, SUITE 190, PLANO, TX 75093-4476
(972) 479-1115
(972) 479-1118
Mailing address
PO BOX 678282, DALLAS, TX 75267-8282
(972) 479-1115
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
—
—
261QX0200X
Oncology Clinic/Center
—
—
Other
Enumeration date
06/11/2010
Last updated
01/19/2018
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