Organization
ST. JAMES PRIMARY CARE (APMC)
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANU PRASAD VELLANKI M.D. (M.D.)
(225) 869-9200
Entity
Organization
Contact information
Practice address
827 PINE ST, GRAMERCY, LA 70052-3659
(225) 869-9200
(225) 869-9241
Mailing address
PO BOX 419, GRAMERCY, LA 70052-0419
(225) 869-9200
(225) 869-9241
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
110
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
057843586A
BLUE CROSS BLUE SHIELD
LA
05
—
1448800
—
LA
01
—
5CE42
MEDICARE GROUP
LA
Enumeration date
06/21/2005
Last updated
06/14/2012
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