Provider Demographics
NPI:1154630226
Name:EFFECTIVE CARE GROUP LLC
Entity Type:Organization
Organization Name:EFFECTIVE CARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VIJAYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHERUKURI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-345-0160
Mailing Address - Street 1:216 PASADENA AVE S
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33707-1251
Mailing Address - Country:US
Mailing Address - Phone:727-345-0160
Mailing Address - Fax:727-345-0100
Practice Address - Street 1:216 PASADENA AVE S
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33707-1251
Practice Address - Country:US
Practice Address - Phone:727-345-0160
Practice Address - Fax:727-345-0100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization