# ST JOSEPH MEDICAL CLINIC A MEDICAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** m dirk ory md a medical corporation
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255348843
- **Authorized official:** RAJA S TALLURI M.D. (PRESIDENT)
- **Authorized official phone:** (225) 265-3061

## Contact information

- **Practice address:** 22080 LA HWY 20, VACHERIE, LA 70090-0069
- **Practice address phone:** (225) 265-3061
- **Practice address fax:** (225) 265-3062
- **Mailing address:** PO BOX 69, VACHERIE, LA 70090-0069
- **Mailing address phone:** (225) 265-3061
- **Mailing address fax:** (225) 265-3062

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QR1300X | Rural Health Clinic/Center | 098 | LA | Yes |

## Other

- **Enumeration date:** 08/03/2006
- **Last updated:** 08/22/2020