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Organization
VISTA PEM PROVIDERS, LLC
Active
Organization
VISTA PEM PROVIDERS, LLC
Active
Other names
Sandra O'neal Institute
Organization subpart
No
Provider details
NPI number
Authorized official
LAURA KASSA (SR VICE PRESIDENT)
(904) 515-0362
Entity
Organization
Contact information
Practice address
5072 W PLANO PKWY, SUITE 190, PLANO, TX 75093-4476
(469) 362-6909
Mailing address
PO BOX 678282, DALLAS, TX 75267-8282
(469) 362-6909
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
—
—
261QR0200X
Radiology Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
282161301
—
TX
01
—
FTN041
MEDICARE PTAN
—
Enumeration date
05/07/2010
Last updated
04/06/2022
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