Provider Demographics
NPI:1801615380
Name:SOUTHWEST LOUISIANA PRIMARY HEALTH CARE CENTER, INC.
Entity type:Organization
Organization Name:SOUTHWEST LOUISIANA PRIMARY HEALTH CARE CENTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DODIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:337-942-3390
Mailing Address - Street 1:8762 HIGHWAY 182
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-5603
Mailing Address - Country:US
Mailing Address - Phone:337-942-3390
Mailing Address - Fax:337-942-8644
Practice Address - Street 1:236 CHURCH HILL ST
Practice Address - Street 2:
Practice Address - City:SUNSET
Practice Address - State:LA
Practice Address - Zip Code:70584-6202
Practice Address - Country:US
Practice Address - Phone:337-942-3390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHWEST LOUISIANA PRIMARY HEALTH CARE CENTER, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-10-10
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)