Organization
HELENA DERMATOLOGY & LASER CLINIC, P.C.
Active
Organization
HELENA DERMATOLOGY & LASER CLINIC, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LATHA SREE VELLANKI M.D. (PRESIDENT)
(406) 443-7200
Entity
Organization
Contact information
Practice address
1 MEDICAL PARK DR, HELENA, MT 59601-8022
(406) 443-7200
(406) 443-7201
Mailing address
PO BOX 1188, HELENA, MT 59624-1188
(406) 443-7210
(406) 443-7201
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000092195
BLUE CROSS BLUE SHIELD
MT
01
—
DD8895
RAILROAD MEDICAR
MT
Enumeration date
10/05/2006
Last updated
10/19/2011
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