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General NPI Number Information
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NPI Number | 1154630226
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Entity Type | Organization
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Legal Business Name | EFFECTIVE CARE GROUP LLC
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Dates
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Enumeration Date | 10/06/2010
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Last Update Date | 10/06/2010
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Provider Practice Location Address
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Address Line | 216 PASADENA AVE S
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City | ST PETERSBURG
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State | FL
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Zip | 33707-1251
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Country | US
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Telephone | 727-345-0160
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Fax | 727-345-0100
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Provider Business Mailing Address
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Address Line | 216 PASADENA AVE S
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City | ST PETERSBURG
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State | FL
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Zip | 33707-1251
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Country | US
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Telephone | 727-345-0160
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Fax | 727-345-0100
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. VIJAYA L CHERUKURI
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Credential | M.D.
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Telephone | 727-345-0160
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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