Provider Demographics
NPI:1245724236
Name:VISIONARY HEALTH BY M2C
Entity type:Organization
Organization Name:VISIONARY HEALTH BY M2C
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORRADINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-271-3250
Mailing Address - Street 1:5900 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-3150
Mailing Address - Country:US
Mailing Address - Phone:937-271-3250
Mailing Address - Fax:
Practice Address - Street 1:5900 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-3150
Practice Address - Country:US
Practice Address - Phone:937-271-3250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-21
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2052380Medicaid
OHCO4083015OtherMEDICARE