Provider Demographics
NPI:1740365113
Name:PRIMARY HEALTH CHOICE INC
Entity type:Organization
Organization Name:PRIMARY HEALTH CHOICE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:THAD
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-865-3500
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:SAINT PAULS
Mailing Address - State:NC
Mailing Address - Zip Code:28384-0159
Mailing Address - Country:US
Mailing Address - Phone:910-865-3500
Mailing Address - Fax:910-865-4124
Practice Address - Street 1:219 W BROAD ST
Practice Address - Street 2:
Practice Address - City:SAINT PAULS
Practice Address - State:NC
Practice Address - Zip Code:28384-1533
Practice Address - Country:US
Practice Address - Phone:910-865-3500
Practice Address - Fax:910-865-4124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300600Medicaid
NC8300600VMedicaid
NC8300600HMedicaid
NC8300600GMedicaid