# VISTA PEM PROVIDERS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225359367
- **Authorized official:** CLERISSA HADLEY (DIRECTOR OF NETWORK DEVELOPMENT)
- **Authorized official phone:** (972) 215-7410

## Contact information

- **Practice address:** 5072 W PLANO PKWY, SUITE 190, PLANO, TX 75093-4476
- **Practice address phone:** (972) 479-1115
- **Practice address fax:** (972) 479-1118
- **Mailing address:** PO BOX 678282, DALLAS, TX 75267-8282
- **Mailing address phone:** (972) 479-1115

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR0200X | Radiology Clinic/Center | — | — | Yes |
| 261QX0200X | Oncology Clinic/Center | — | — | — |

## Other

- **Enumeration date:** 06/11/2010
- **Last updated:** 01/19/2018