# VISTA PEM PROVIDERS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Sandra O'neal Institute
- **Organization subpart:** No

## Provider details

- **NPI number:** 1881912335
- **Authorized official:** LAURA KASSA (SR VICE PRESIDENT)
- **Authorized official phone:** (904) 515-0362

## Contact information

- **Practice address:** 5072 W PLANO PKWY, SUITE 190, PLANO, TX 75093-4476
- **Practice address phone:** (469) 362-6909
- **Mailing address:** PO BOX 678282, DALLAS, TX 75267-8282
- **Mailing address phone:** (469) 362-6909

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2085R0202X | Diagnostic Radiology Physician | — | — | — |
| 261QR0200X | Radiology Clinic/Center | — | — | Yes |

## Other

- **Enumeration date:** 05/07/2010
- **Last updated:** 04/06/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 282161301 | — | TX |
| 01 | — | FTN041 | MEDICARE PTAN | — |