Organization
ST JOSEPH MEDICAL CLINIC A MEDICAL CORPORATION
Active
Other names
m dirk ory md a medical corporation
Organization subpart
No
Provider details
NPI number
Authorized official
RAJA S TALLURI M.D. (PRESIDENT)
(225) 265-3061
Entity
Organization
Contact information
Practice address
22080 LA HWY 20, VACHERIE, LA 70090-0069
(225) 265-3061
(225) 265-3062
Mailing address
PO BOX 69, VACHERIE, LA 70090-0069
(225) 265-3061
(225) 265-3062
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
098
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1449792
—
LA
Enumeration date
08/03/2006
Last updated
08/22/2020
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