Organization
ZACHARY INTERNAL MEDICINE CLINIC, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VENU BABU KAKARALA MD (OWNER)
(225) 570-2732
Entity
Organization
Contact information
Practice address
1169 HIGHWAY 19 STE B, SLAUGHTER, LA 70777-3404
(225) 570-2257
(225) 286-4078
Mailing address
1169 HIGHWAY 19 STE B, SLAUGHTER, LA 70777-3404
(225) 570-2257
(225) 862-4078
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2515802
—
LA
Enumeration date
08/17/2016
Last updated
11/08/2021
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