Multi-Specialty & Primary Care Practice Group of Lake Wales LLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

MULTI-SPECIALTY & PRIMARY CARE PRACTICE GROUP OF LAKE WALES LLC

Practice address

1255 State Road 60 East
Lake Wales, FL 33853

Phone

(863) 232-5111

Fax

(866) 922-0875

NPI assigned

Oct 31, 2008

Last updated

Apr 8, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Kollagunta S Chandrasekhar, M.D.

Title

Owner

Phone

(863) 294-5505

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1225411200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239148800000",
    "number": "1467605634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1255 STATE ROAD 60 EAST",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "33853",
            "telephone_number": "863-232-5111",
            "fax_number": "866-922-0875"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1255 STATE ROAD 60 EAST",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "33853",
            "telephone_number": "863-232-5111",
            "fax_number": "866-922-0875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MULTI-SPECIALTY & PRIMARY CARE PRACTICE GROUP OF LAKE WALES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-31",
        "last_updated": "2009-04-08",
        "status": "A",
        "authorized_official_last_name": "CHANDRASEKHAR",
        "authorized_official_first_name": "KOLLAGUNTA",
        "authorized_official_middle_name": "S",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "863-294-5505",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Lake Wales, FL
• Providers in Lake Wales, FL by specialty
• Specialist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 8, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.