| Organization Name: | SOUTHTOWN MEDICAL CENTER, LLC |
| NPI Number: | 1629022058 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | VENKATA A VALLURY (CEO) |
| Mailing Address: | 6342 S Pulaski Rd Chicago |
| State: | IL US |
| Postal Code: | 606294706 |
| Phone Number: | 7732848601 |
| Fax Number: | |
| NPI Enumeration Date: | 05/20/2006 |
| NPI Last Update Date: | 05/02/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |