1851316004 NPI number — PRIME CARE NETWORK OF MONROE, LLC

Table of content: (NPI 1851316004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851316004 NPI number — PRIME CARE NETWORK OF MONROE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIME CARE NETWORK OF MONROE, LLC
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:
6
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:
1851316004
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3010 LYNDON B JOHNSON FWY STE 1100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75234-2712
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-379-1600
Provider Business Mailing Address Fax Number:
903-537-8470

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 E REYNOLDS DR STE D-1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RUSTON
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
71270-2809
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
318-255-2600
Provider Business Practice Location Address Fax Number:
318-513-1013
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MONASTIERE
Authorized Official First Name:
KATIE
Authorized Official Middle Name:
Authorized Official Title or Position:
COMPLIANCE,PRIVACY,& SAFETY OFFICER
Authorized Official Telephone Number:
517-768-4373

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  928 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1402168 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com