1609120682 NPI number — SOUTHWEST LOUISIANA PRIMARY HEALTH CARE CENTER INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609120682 NPI number — SOUTHWEST LOUISIANA PRIMARY HEALTH CARE CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST LOUISIANA PRIMARY HEALTH CARE CENTER INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NORTHSIDE COMMUNITY HEALTH CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609120682
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1815
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OPELOUSAS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70571-1815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
337-942-3390
Provider Business Mailing Address Fax Number:
337-942-8644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 LOUISIANA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAFAYETTE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70501-3702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
337-942-3390
Provider Business Practice Location Address Fax Number:
337-942-8644
Provider Enumeration Date:
10/30/2012

Additional Information

Authorized Official

Authorized Official Last Name:
LAMOTT
Authorized Official First Name:
DODIE
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
337-942-3390

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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