St Joseph Medical Clinic A Medical Corporation | |
22080 La Hwy 20 Vacherie LA 70090-0069 | |
(225) 265-3061 | |
(225) 265-3062 |
Full Name | St Joseph Medical Clinic A Medical Corporation |
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Speciality | Clinic/Center |
Location | 22080 La Hwy 20, Vacherie, Louisiana |
Authorized Official Name and Position | Raja S Talluri (PRESIDENT) |
Authorized Official Contact | 2252653061 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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St Joseph Medical Clinic A Medical Corporation Po Box 69 Vacherie LA 70090-0069 Ph: (225) 265-3061 | St Joseph Medical Clinic A Medical Corporation 22080 La Hwy 20 Vacherie LA 70090-0069 Ph: (225) 265-3061 |
NPI Number | 1255348843 |
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Provider Enumeration Date | 08/03/2006 |
Last Update Date | 08/22/2020 |
Medicare PECOS PAC ID | 9335189109 |
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Medicare Enrollment ID | O20050511000427 |
Identifier | Type | State | Issuer |
---|---|---|---|
1255348843 | NPI | - | NPPES |
1449792 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
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261QR1300X | Clinic/center - Rural Health | 098 (Louisiana) | Primary |
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