Provider Demographics
NPI:1164428629
Name:ST. JAMES PRIMARY CARE (APMC)
Entity Type:Organization
Organization Name:ST. JAMES PRIMARY CARE (APMC)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:ANU
Authorized Official - Middle Name:PRASAD
Authorized Official - Last Name:VELLANKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-869-9200
Mailing Address - Street 1:PO BOX 419
Mailing Address - Street 2:
Mailing Address - City:GRAMERCY
Mailing Address - State:LA
Mailing Address - Zip Code:70052-0419
Mailing Address - Country:US
Mailing Address - Phone:225-869-9200
Mailing Address - Fax:225-869-9241
Practice Address - Street 1:827 PINE ST
Practice Address - Street 2:
Practice Address - City:GRAMERCY
Practice Address - State:LA
Practice Address - Zip Code:70052-3659
Practice Address - Country:US
Practice Address - Phone:225-869-9200
Practice Address - Fax:225-869-9241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA110261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CE42OtherMEDICARE GROUP
LA057843586AOtherBLUE CROSS BLUE SHIELD
LA1448800Medicaid
LA193870Medicare Oscar/Certification