Provider Demographics
NPI:1568690535
Name:PRIMARY HEALTHCARE OF SOUTHEAST LA LLC
Entity Type:Organization
Organization Name:PRIMARY HEALTHCARE OF SOUTHEAST LA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:THANE
Authorized Official - Middle Name:BATTISTE
Authorized Official - Last Name:PAINIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-620-1561
Mailing Address - Street 1:57935 MCDANIEL ST
Mailing Address - Street 2:
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70764-2039
Mailing Address - Country:US
Mailing Address - Phone:225-620-1561
Mailing Address - Fax:225-687-9904
Practice Address - Street 1:57935 MCDANIEL ST
Practice Address - Street 2:
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764-2039
Practice Address - Country:US
Practice Address - Phone:225-620-1561
Practice Address - Fax:225-687-9904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-29
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)