MADHUSUDAN VALLALA M.D., S.C. (NPI# 1609177005) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1609177005 |
| Entity Type | Organization |
| Organization Name | MADHUSUDAN VALLALA M.D., S.C. |
| Practice Address |
1515 W Walnut St Jacksonville IL 62650-1150 |
| Practice Telephone | 2172458712 |
| Practice Fax Number | 2172451453 |
| Mailing Telephone | 2172458712 |
| Mailing Fax Number | 2172451453 |
| Enumeration Date | 2010-11-16 |
| Last Update Date | 2010-11-16 |
| Authorized Official Name | MRS. SUE VALLALA (OFFICE MANAGER) |
| Authorized Official Telephone | 2172458712 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RC0000X |
Internal Medicine Specialization: Cardiovascular Disease |
036053208 | IL | Allopathic & Osteopathic Physicians |
| Street Address |
1515 W WALNUT ST |
| City | JACKSONVILLE |
| State | IL |
| Zip Code | 62650-1150 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558333633 | Allen G Gerberding | Family Medicine | 1515 W Walnut St, Jacksonville, IL 62650-1150 | 2006-02-03 |
| 1740777093 | Tamara Breckon | Nurse Practitioner | 1515 W Walnut St, Jacksonville, IL 62650 | 2018-04-21 |
| 1629465414 | Hshs Medical Group Inc | Durable Medical Equipment & Medical Supplies | 1515 W Walnut St, Suite 12, Jacksonville, IL 62650-1150 | 2015-04-20 |
| 1164848750 | Smile Experts Dental Associates | Exclusive Provider Organization | 1515 W Walnut St, Jacksonville, IL 62650-1150 | 2014-03-06 |
| 1295068856 | Eldon G. Barrowes | Dentist | 1515 W Walnut St, Bldg. #3, Jacksonville, IL 62650-1150 | 2009-09-15 |
| 1962650150 | Lynch Family Dentistry, P.C. | Clinic/Center | 1515 W Walnut St, Building 5, Jacksonville, IL 62650-1150 | 2008-09-03 |
| 1891960753 | Ronald R Lynch Dmd Ltd | Clinic/Center | 1515 W Walnut St, Jacksonville, IL 62650-1150 | 2008-04-22 |
| 1295952422 | Robert A. Krueger, D.d.s., Ltd. | Dentist | 1515 W Walnut St, #8, Jacksonville, IL 62650-1150 | 2007-04-19 |
| 1477677995 | Foot and Ankle Associates of Central Illinois LLC | Durable Medical Equipment & Medical Supplies | 1515 W Walnut St, Suite 12, Jacksonville, IL 62650-1150 | 2007-03-19 |
| 1497883862 | Thomas Michael Loughary | Dentist | 1515 W Walnut St, Building 10, Jacksonville, IL 62650-1150 | 2007-02-28 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134768708 | Stephanie Lee Mabus | Occupational Therapy Assistant | 873 Gorve St, Jacksonville, IL 62650 | 2019-12-31 |
| 1285281071 | Sharshon Pharmacy Inc | Pharmacy | 154 W Morton Ave, Jacksonville, IL 62650 | 2019-08-26 |
| 1992275499 | Brittany Ruth Helmich | Counselor | 340 W. State St., Jacksonville, IL 62650 | 2018-11-28 |
| 1811391782 | Rodney E. Overstreet | Hearing Instrument Specialist | 1521 W. Walnut, Jacksonville, IL 62650 | 2014-10-21 |
| 1407979818 | Jan Ala | Speech-Language Pathologist | 1111 W Morton, Speechworks, Jacksonville, IL 62650 | 2007-04-09 |
| 1083787592 | Eldon G Barrowes Dds & Assoc PC | Dentist | 1515 West Walnut, Bldg #3, Jacksonville, IL 62650 | 2006-11-15 |
| 1194895979 | Joseph J Kozma | Internal Medicine | 1440 West Walnut, Jacksonville, IL 62650 | 2006-11-08 |
| 1740350529 | Susan Weller | Dentist | 1614 West Lafayette Avenue, Jackson, IL 62650 | 2006-11-08 |
| 1659467793 | Shawn M Fry | Family Medicine | 610 N. Westgate, Jacksonville, IL 62650 | 2006-10-05 |
| 1518050061 | Ward Richard Dunseth II | Nurse Anesthetist, Certified Registered | 1400 W Walnut, Jacksonville, IL 62650 | 2006-10-02 |
| Find all providers in zip 62650 | ||||
| Taxonomy Code | 207RC0000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Cardiovascular Disease |
| An internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threatening, abnormal heartbeat rhythms. |
| Notes: Source: American Osteopathic Board of Internal Medicine, 2008 [7/1/2008: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, http://www.abim.org/. American Osteopathic Board of Internal Medicine, https://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598182552 | Maedeh Ganji | Internal Medicine | 653 W 8th St # L-18, Jacksonville, FL 32209-6511 | 2014-03-27 |
| 1649696691 | Carolinaeast Physicians | Internal Medicine | 4725 Western Blvd, Jacksonville, NC 28546-6852 | 2014-03-14 |
| 1093151888 | Alejandro Pena Jr. | Internal Medicine | 14546 Old St Augustine Rd Suite 201, Jacksonville, FL 32258-2612 | 2013-05-20 |
| 1669696407 | Ruple Jayantilal Galani | Internal Medicine | 14546 Old Saint Augustine Rd Ste 103, Credentialing Department, Jacksonville, FL 32258-5469 | 2007-04-12 |
| 1154408656 | Heart Clinic of Jacksonville, LLC | Internal Medicine | 9551 Baymeadows Rd Ste 6, Jacksonville, FL 32256-7938 | 2006-11-01 |
| 1487757092 | Cardiovascular Associates of Jacksonville Pa | Internal Medicine | 3599 University Blvd South, Suite 913, Jacksonville, FL 32216-4269 | 2006-09-07 |
| 1316958838 | Valerie Mcnee | Internal Medicine | 1 Red Fox Ln, Jacksonville, AR 72076-2513 | 2006-08-10 |
| 1306895438 | Diagnostic Cardiology Pa | Internal Medicine | 6867 South Point Drive N, Suite 111, Jacksonville, FL 32216-8005 | 2006-05-08 |
| 1790743854 | Baptist Cardiology, Inc. | Internal Medicine | 1905 Corporate Square Blvd, Jacksonville, FL 32216-1940 | 2006-05-01 |
| 1386601896 | James C Campbell | Internal Medicine | 3225 University Blvd S Ste 104, Credentialing Department, Jacksonville, FL 32216-2757 | 2006-04-27 |
| Find all providers in JACKSONVILLE | ||||
| City | JACKSONVILLE |
| Zip Code | 62650 |
Please comment or provide details below to improve the information on MADHUSUDAN VALLALA M.D., S.C..
| 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.