Provider Demographics
NPI:1093843187
Name:SOUTHWEST LOUISIANA PRIMARY HEALTH CARE CENTER, INC
Entity Type:Organization
Organization Name:SOUTHWEST LOUISIANA PRIMARY HEALTH CARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
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:PO BOX 1815
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70571-1815
Mailing Address - Country:US
Mailing Address - Phone:337-942-2005
Mailing Address - Fax:337-942-8644
Practice Address - Street 1:8762 HIGHWAY 182
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-5603
Practice Address - Country:US
Practice Address - Phone:337-942-2005
Practice Address - Fax:337-942-8644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2015-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1941859Medicaid
LA1941859Medicaid
LA191817Medicare ID - Type UnspecifiedFACILTY FQHC PROVIDER #