Vincent D. Mallory Md., Llc | |
3311 Prescott Rd Suite 316 Alexandria LA 71301-3900 | |
(318) 487-1717 | |
(318) 487-1170 |
Full Name | Vincent D. Mallory Md., Llc |
---|---|
Speciality | Clinic/Center |
Location | 3311 Prescott Rd, Alexandria, Louisiana |
Authorized Official Name and Position | Constance Fisher Mallory (OFFICE MANGER) |
Authorized Official Contact | 3184871717 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Vincent D. Mallory Md., Llc 3311 Prescott Rd Suite 316 Alexandria LA 71301-3900 Ph: (318) 487-1717 | Vincent D. Mallory Md., Llc 3311 Prescott Rd Suite 316 Alexandria LA 71301-3900 Ph: (318) 487-1717 |
NPI Number | 1215201215 |
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Provider Enumeration Date | 03/08/2012 |
Last Update Date | 03/08/2012 |
Medicare PECOS PAC ID | 3375703754 |
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Medicare Enrollment ID | O20120321000762 |
Identifier | Type | State | Issuer |
---|---|---|---|
1215201215 | NPI | - | NPPES |
1574520 | Medicaid | LA | |
1215918503 | Other | LA | NPI-INDIVIDUAL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
Provider Name | Vincent D Mallory |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1215918503 PECOS PAC ID: 3375703762 Enrollment ID: I20120321000783 |
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