# VISTA HEALTHCARE LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

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

## Provider details

- **NPI number:** 1417582875
- **Authorized official:** JEREMY BUCKNER DC (OWNER)
- **Authorized official phone:** (602) 421-2730

## Contact information

- **Practice address:** 1001 E WARNER RD STE 107, TEMPE, AZ 85284-3224
- **Practice address phone:** (480) 897-3300
- **Mailing address:** PO BOX 11180, TEMPE, AZ 85284-0020

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | NULL | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | — | — | Yes |
| 261Q00000X | Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 03/05/2020
- **Last updated:** 03/05/2020