1609182575 NPI number — PRIMARY HEALTH CHOICE, INC.

Table of content: (NPI 1609182575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609182575 NPI number — PRIMARY HEALTH CHOICE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIMARY HEALTH CHOICE, 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:
Provider Other Organization Name Type Code:
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:
1609182575
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 159
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAINT PAULS
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28384-0159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4701 FAYETTEVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUMBERTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28358-2697
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-738-3939
Provider Business Practice Location Address Fax Number:
910-738-3938
Provider Enumeration Date:
08/30/2010

Additional Information

Authorized Official

Authorized Official Last Name:
LOCKLEAR
Authorized Official First Name:
ASHLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
FINANCE DIRECTOR
Authorized Official Telephone Number:
910-865-3500

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 5906542 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6008617 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8302374H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3410063 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5912446 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5921147 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6006778 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8301851H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8303235R , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5918940 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6005252 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6006974 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6008059 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6008845 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8303235G , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6006729 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6008848 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8302178H , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8703060 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5919214 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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