Provider Demographics
NPI:1972516672
Name:NARAYANA G MEMULA,MDPC
Entity Type:Organization
Organization Name:NARAYANA G MEMULA,MDPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NARAYANA
Authorized Official - Middle Name:G
Authorized Official - Last Name:MEMULA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:573-778-1131
Mailing Address - Street 1:6770 BROWN LANE
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-8652
Mailing Address - Country:US
Mailing Address - Phone:573-778-1131
Mailing Address - Fax:
Practice Address - Street 1:2620 N WESTWOOD BLVD
Practice Address - Street 2:CANCER CENTER
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-3396
Practice Address - Country:US
Practice Address - Phone:573-785-7721
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0203XAllopathic & Osteopathic PhysiciansRadiologyTherapeutic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E68262Medicare UPIN