Southtown Medical Center, Llc

LBN: Southtown Medical Center, Llc
Southtown Medical Center, Llc is an health care organization with primary practice located at 6342 S Pulaski Rd , Chicago IL 60629-4706. The organization recently has 3 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Family Medicine, Allopathic & Osteopathic Physicians / Pediatrics, Allopathic & Osteopathic Physicians / General Practice. Allopathic & Osteopathic Physicians / Family Medicine is the primary health care specialty. Southtown Medical Center, Llc can be contacted via phone (773) 284-8601, or through Vallury, Venkata A via phone (773) 284-8601.

Contact Information

Primary practice address
6342 S Pulaski Rd Chicago IL 60629-4706
Phone: (773) 284-8601
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Vallury, Venkata A Doctor of Medicine (MD)
Phone: (773) 284-8601

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X Illinois
Allopathic & Osteopathic Physicians / Pediatrics 208000000X Illinois
Allopathic & Osteopathic Physicians / General Practice 208D00000X Illinois

Profile Details

NPI number 1629022058
LBN Legal business name Southtown Medical Center, Llc
DBA Doing business as
Authorized official Vallury, Venkata A Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date May 20th, 2006
Last updated May 2nd, 2008 - about 18 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1629022058 NPPES
Illinois MEDICAID 036069911
Illinois MEDICAID 036101348
Illinois Other 1174528061
Illinois Other 1356346241
Illinois Other 1634276

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