Provider Demographics
NPI:1346273190
Name:PRIMARY CARE SPECIALISTS,LLC
Entity Type:Organization
Organization Name:PRIMARY CARE SPECIALISTS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARIFA
Authorized Official - Middle Name:PANYA
Authorized Official - Last Name:BAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-487-6060
Mailing Address - Street 1:3802 PRESCOTT RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3731
Mailing Address - Country:US
Mailing Address - Phone:318-487-6060
Mailing Address - Fax:318-880-0359
Practice Address - Street 1:3802 PRESCOTT RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3731
Practice Address - Country:US
Practice Address - Phone:318-487-6060
Practice Address - Fax:318-880-0359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD025431207Q00000X
LAMD025432207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1577880Medicaid
LA1577880Medicaid
LA4E298Medicare ID - Type Unspecified