Provider Demographics
NPI:1700951951
Name:PRIME HEALTH LLC
Entity Type:Organization
Organization Name:PRIME HEALTH LLC
Other - Org Name:PRIME HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MEICHI
Authorized Official - Middle Name:C
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:225-687-2001
Mailing Address - Street 1:59295 RIVERWEST DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:PLAQUEMINE
Mailing Address - State:LA
Mailing Address - Zip Code:70764
Mailing Address - Country:US
Mailing Address - Phone:225-687-2001
Mailing Address - Fax:225-687-9519
Practice Address - Street 1:59295 RIVERWEST DR
Practice Address - Street 2:SUITE C
Practice Address - City:PLAQUEMINE
Practice Address - State:LA
Practice Address - Zip Code:70764
Practice Address - Country:US
Practice Address - Phone:225-687-2001
Practice Address - Fax:225-687-9519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2014-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA003207Q00000X, 261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1440051Medicaid
LA193840Medicare ID - Type Unspecified
LA1440051Medicaid