Provider Demographics
NPI:1235427279
Name:PRIMARY HEALTH CHOICE, INC.
Entity Type:Organization
Organization Name:PRIMARY HEALTH CHOICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:LOCKLEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-865-3500
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:SAINT PAULS
Mailing Address - State:NC
Mailing Address - Zip Code:28384-0159
Mailing Address - Country:US
Mailing Address - Phone:910-865-3500
Mailing Address - Fax:
Practice Address - Street 1:505 ATKINSON ST
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-3715
Practice Address - Country:US
Practice Address - Phone:910-227-0001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-12
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3410063Medicaid
NC5919023Medicaid
NC8303395Medicaid
NC8303395SMedicaid
NC6008773Medicaid
NC8303395RMedicaid