Provider Demographics
NPI:1336430594
Name:PRIMARY HEALTH SOLUTIONS, LLC
Entity Type:Organization
Organization Name:PRIMARY HEALTH SOLUTIONS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADULT ACUTE CARE NURSE PRACTITIONER
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BUCKHEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:ACNP
Authorized Official - Phone:228-354-9505
Mailing Address - Street 1:PO BOX 6190
Mailing Address - Street 2:
Mailing Address - City:DIBERVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39540-6190
Mailing Address - Country:US
Mailing Address - Phone:228-354-9505
Mailing Address - Fax:228-354-9575
Practice Address - Street 1:10404 TUCKER RD
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39565-7922
Practice Address - Country:US
Practice Address - Phone:228-354-9505
Practice Address - Fax:228-354-9575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-22
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS6705261Q00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS3630279Medicaid