| Organization Name: | ST JOSEPH MEDICAL CLINIC A MEDICAL CORPORATION |
| NPI Number: | 1255348843 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RAJA S TALLURI (PRESIDENT) |
| Mailing Address: | 22080 La Hwy 20 Vacherie |
| State: | LA US |
| Postal Code: | 700900069 |
| Phone Number: | 2252653061 |
| Fax Number: | 2252653062 |
| NPI Enumeration Date: | 08/03/2006 |
| NPI Last Update Date: | 04/20/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR1300X |
| License Number: | 098 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | LA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Rural Health |
| Taxonomy Definition: | |