Organization Name: | ST. JAMES PRIMARY CARE, APMC |
NPI Number: | 1346429453 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ANU PRASAD VELLANKI (DOCTOR) |
Mailing Address: | 827 N Pine St Gramercy |
State: | LA US |
Postal Code: | 700523659 |
Phone Number: | 2258699200 |
Fax Number: | |
NPI Enumeration Date: | 10/25/2007 |
NPI Last Update Date: | 06/29/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 1444111 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | LA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |