Provider Demographics
NPI:1114583994
Name:PRIMESOURCE NURSING SERVICES, INC
Entity Type:Organization
Organization Name:PRIMESOURCE NURSING SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RHETT
Authorized Official - Middle Name:
Authorized Official - Last Name:PLAUCHE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-865-1330
Mailing Address - Street 1:PO BOX 6705
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39506-6705
Mailing Address - Country:US
Mailing Address - Phone:228-865-1330
Mailing Address - Fax:228-865-1331
Practice Address - Street 1:2279 ATKINSON RD
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2209
Practice Address - Country:US
Practice Address - Phone:228-865-1330
Practice Address - Fax:228-865-1331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-16
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty