Gorantla Govindaiah, M.D., S.C.

LBN: Gorantla Govindaiah, M.D., S.C.
Gorantla Govindaiah, M.D., S.C. is an health care organization with primary practice located at 4366 Kennedy Dr Suite B, East Moline IL 61244-4288. The organization recently has only one registered license in Ambulatory Health Care Facilities / Health Service, which is considered as the primary health care specialty. Gorantla Govindaiah, M.D., S.C. can be contacted via phone (309) 796-1510, or through Govindaiah, Gorantla via phone (309) 796-1510.

Contact Information

Primary practice address
4366 Kennedy Dr Suite B East Moline IL 61244-4288
Phone: (309) 796-1510
Fax: (309) 796-1565
Website:
Map and Directions
Authorized official contact:
Name: Govindaiah, Gorantla Doctor of Medicine (MD)
Phone: (309) 796-1510

Health care specialties

SpecialtyCodeLicense #State
Ambulatory Health Care Facilities / Health Service 261QH0100X

Profile Details

NPI number 1023222502
LBN Legal business name Gorantla Govindaiah, M.D., S.C.
DBA Doing business as
Authorized official Govindaiah, Gorantla Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date May 10th, 2007
Last updated May 15th, 2008 - about 17 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 1023222502 NPPES
Illinois Other 263500 MEDICARE GROUP
Illinois Other 8100279 MEDICARE GROUP
Illinois MEDICAID 036049003 MEDICARE GROUP
Illinois Other K44585 MEDICARE GROUP
Illinois Other 010063712 MEDICARE GROUP
Illinois Other 98669 MEDICARE GROUP

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