Zachary Internal Medicine Clinic Llc | |
1169 Highway 19 Ste B Slaughter LA 70777-3404 | |
(225) 570-2257 | |
(225) 286-4078 |
Full Name | Zachary Internal Medicine Clinic Llc |
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Speciality | Clinic/Center |
Location | 1169 Highway 19 Ste B, Slaughter, Louisiana |
Authorized Official Name and Position | Venu Babu Kakarala (OWNER) |
Authorized Official Contact | 2255702257 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Zachary Internal Medicine Clinic Llc 1169 Highway 19 Ste B Slaughter LA 70777-3404 Ph: (225) 570-2257 | Zachary Internal Medicine Clinic Llc 1169 Highway 19 Ste B Slaughter LA 70777-3404 Ph: (225) 570-2257 |
NPI Number | 1568488849 |
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Provider Enumeration Date | 07/13/2006 |
Last Update Date | 11/08/2021 |
Medicare PECOS PAC ID | 1052324613 |
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Medicare Enrollment ID | O20060726000348 |
Identifier | Type | State | Issuer |
---|---|---|---|
1568488849 | NPI | - | NPPES |
1569097 | Medicaid | LA |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
Provider Name | Venu B Kakarala |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1538166822 PECOS PAC ID: 6002857208 Enrollment ID: I20050518000566 |
Provider Name | Amy B Tomb |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1497019376 PECOS PAC ID: 1951567197 Enrollment ID: I20120717000010 |
Provider Name | Mallory S Bankston |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1174938211 PECOS PAC ID: 7416242524 Enrollment ID: I20160827000167 |
Provider Name | Elizabeth A Frazier |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1427453745 PECOS PAC ID: 8224334271 Enrollment ID: I20161122001683 |
Provider Name | Lauri Garrett |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1063082279 PECOS PAC ID: 7517362163 Enrollment ID: I20210820000927 |
Provider Name | Heather P Garrot |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1972289031 PECOS PAC ID: 1153775986 Enrollment ID: I20230928000651 |
Slaughter Health Center Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 3166 Church St, Slaughter, LA 70777 Phone: 225-683-1370 Fax: 225-658-6500 | |
Zachary Internal Medicine Clinic, Llc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1169 Highway 19 Ste B, Slaughter, LA 70777 Phone: 225-570-2257 Fax: 225-286-4078 |