Provider Demographics
NPI:1407171721
Name:PLAQUEMINES PRIMARY CARE, INC.
Entity Type:Organization
Organization Name:PLAQUEMINES PRIMARY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PREST
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:504-564-0848
Mailing Address - Street 1:27136 HWY 23
Mailing Address - Street 2:SUITE A
Mailing Address - City:PORT SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70083
Mailing Address - Country:US
Mailing Address - Phone:504-564-0848
Mailing Address - Fax:504-564-0849
Practice Address - Street 1:27136 HWY 23
Practice Address - Street 2:SUITE A
Practice Address - City:PORT SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70083
Practice Address - Country:US
Practice Address - Phone:504-564-0848
Practice Address - Fax:504-564-0849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-30
Last Update Date:2020-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care