Provider Demographics
NPI:1548929110
Name:VISIONARY ALLIANCE HEALTHCARE INVESTMENT, LLC
Entity type:Organization
Organization Name:VISIONARY ALLIANCE HEALTHCARE INVESTMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:MORLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-840-4038
Mailing Address - Street 1:5705 N SCOTTSDALE RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85250-5910
Mailing Address - Country:US
Mailing Address - Phone:480-948-0560
Mailing Address - Fax:
Practice Address - Street 1:5705 N SCOTTSDALE RD STE 110
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85250-5910
Practice Address - Country:US
Practice Address - Phone:480-948-0560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty