Organization
VERNON INTERNAL MEDICINE CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KANCHAN PRASAD UPADHYAY MD (BUISNESS OWNER)
(337) 238-3475
Entity
Organization
Contact information
Practice address
931 VERONE TER, SUITE A, LEESVILLE, LA 71446-4272
(337) 238-3475
(337) 238-3475
Mailing address
931 VERONE TER, SUITE A, LEESVILLE, LA 71446-4272
(337) 238-3475
(337) 238-3475
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0508695280
BLUECROSS BLUE SHEILD
LA
05
—
1578924
—
LA
01
—
36-00370
UNITED HEALTH CARE
LA
Enumeration date
07/07/2006
Last updated
03/10/2020
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