| Matta Medical Clinic Llc | |
|
647 Bienville Cir Natchitoches LA 71457-5744 | |
| (318) 238-5990 | |
| Not Available |
| Full Name | Matta Medical Clinic Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 647 Bienville Cir, Natchitoches, Louisiana |
| Authorized Official Name and Position | Sujatha Gubbala (MANAGER) |
| Authorized Official Contact | 3182385990 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Matta Medical Clinic Llc Po Box 7111 Natchitoches LA 71457-0111 Ph: () - | Matta Medical Clinic Llc 647 Bienville Cir Natchitoches LA 71457-5744 Ph: (318) 238-5990 |
| NPI Number | 1881174027 |
|---|---|
| Provider Enumeration Date | 08/16/2018 |
| Last Update Date | 08/16/2018 |
| Medicare PECOS PAC ID | 0749533396 |
|---|---|
| Medicare Enrollment ID | O20181029000900 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881174027 | NPI | - | NPPES |
| 2387766 | Medicaid | LA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Anil S Matta |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1871795674 PECOS PAC ID: 6507951258 Enrollment ID: I20070926001082 |
| Provider Name | Sujatha Gubbala |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1164818894 PECOS PAC ID: 6800175845 Enrollment ID: I20181029000993 |
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