Basic Information
| Provider Information | |||||||||
| NPI: | 1801229869 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | VIZION ONE, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 N WOODLAWN BUILDING ONE STE 227 | ||||||||
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| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672083672 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 555 N WOODLAWN ST STE 227 | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672083672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2025450211 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2013 | ||||||||
| LastUpdateDate: | 08/14/2013 | ||||||||
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| AuthorizedOfficialLastName: | KITWARA | ||||||||
| AuthorizedOfficialFirstName: | ABDALLAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 2025450211 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | A-087-148 | KS | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | A-087-148 | 05 | KS | MEDICAID |