ST JOSEPH MEDICAL CLINIC A MEDICAL CORPORATION (NPI# 1255348843) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255348843 |
| Entity Type | Organization |
| Organization Name | ST JOSEPH MEDICAL CLINIC A MEDICAL CORPORATION |
| Other Organization Name | M DIRK ORY MD A MEDICAL CORPORATION |
| Practice Address |
22080 La Hwy 20 Vacherie LA 70090-0069 |
| Mailing Address |
Po Box 69 Vacherie LA 70090-0069 |
| Practice Telephone | 2252653061 |
| Practice Fax Number | 2252653062 |
| Mailing Telephone | 2252653061 |
| Mailing Fax Number | 2252653062 |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | RAJA S TALLURI (PRESIDENT) |
| Authorized Official Telephone | 2252653061 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QR1300X |
Clinic/Center Specialization: Rural Health |
098 | LA | Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| LA | 1449792 | 05 |
| Other Name | Type Code |
|---|---|
| m dirk ory md a medical corporation | Former Legal Business Name - Organization |
| Street Address |
22080 LA HWY 20 |
| City | VACHERIE |
| State | LA |
| Zip Code | 70090-0069 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144284860 | Raja S Talluri | Internal Medicine | 22080 La Hwy 20, Vacherie, LA 70090 | 2006-04-12 |
| 1265893739 | Denise Louque | Nurse Practitioner | 22080 La Hwy 20, Vacherie, LA 70090 | 2016-03-11 |
| 1518346394 | Marissa Diaz | Physician Assistant | 22080 La Hwy 20, Vacherie, LA 70090 | 2015-05-26 |
| 1962410597 | Michael Dirk Ory | Family Medicine | 22080 La Hwy 20, Vacherie, LA 70090 | 2006-08-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730618315 | Arthur John Bosworth Iv | Case Manager/Care Coordinator | 2645 S Bank Ln, Vacherie, LA 70090 | 2017-06-07 |
| 1659735934 | Njaya Bethancourt | Counselor | 2140 Church St, Vacherie, LA 70090 | 2016-04-12 |
| 1780052340 | Emily Ann Earline Lassere | Specialist/Technologist | 19566 Lonnie Ln, Vacherie, LA 70090 | 2015-09-11 |
| 1912321225 | Theresa Jenkins | Physical Therapist | 22140 Hwy 20, Suite A, Vacherie, LA 70090 | 2014-02-06 |
| 1790906766 | Roland S Waguespack Md | Pharmacy | 1108 St James Street, Vacherie, LA 70090 | 2007-05-01 |
| 1134208002 | James J Stafford | Dentist | 2670 Hwy. 20, Vacherie, LA 70090 | 2006-11-03 |
| 1881708865 | Green Tree Pharmacies LLC | Pharmacy | 21430 La Highway 20, Vacherie, LA 70090 | 2006-08-18 |
| 1659309201 | Vacherie Dialysis Center, Inc. | Clinic/Center | 2504 Hwy. 20, Suite B, Vacherie, LA 70090 | 2006-06-30 |
| 1790729689 | Nephrology Associates | Specialist | 2504 Hwy 20 West, Vacherie, LA 70090 | 2006-06-15 |
| 1366419442 | Lydia W Norton | Pediatrics | St. Philip Clinic, 1108 St. James St., Vacherie, LA 70090 | 2006-03-07 |
| Find all providers in zip 70090 | ||||
| Taxonomy Code | 261QR1300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rural Health |
| Definition to come... |
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| 1760089791 | Blanchard Medical | Clinic/Center | 5948 N Market St, Shreveport, LA 71107-2017 | 2020-10-02 |
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| 1720606478 | Dr Lawanda Lamar Bellamy Md A Professional Medical Corporation | Clinic/Center | 1307 Crowley-rayne Hwy, Suite B, Crowley, LA 70526 | 2020-07-09 |
| 1669002002 | Franklin Parish Hospital Service Dist 1 | Clinic/Center | 7645 Gilbert Street, Gilbert, LA 71336 | 2020-01-24 |
| 1184260937 | Children's International, LLC | Clinic/Center | 5151 Plank Rd Ste 190, Baton Rouge, LA 70805-3501 | 2019-11-26 |
| 1003467440 | Clhg-acadian LLC | Clinic/Center | 151 Hill St Ste 102, Eunice, LA 70535-5845 | 2019-09-26 |
| 1164073524 | Tangi Wellness & Health | Clinic/Center | 906 C M Fagan Dr Ste B3, Hammond, LA 70403-6056 | 2019-09-26 |
| 1679126510 | Pediatric Group of Acadiana, LLC | Clinic/Center | 1307 Crowley Rayne Hwy Ste C, Crowley, LA 70526-8210 | 2019-07-19 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.