MEDICARE: PRIMARY HEALTH CHOICE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1881834497
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY HEALTH CHOICE, INC.

Provider Business Mailing Address
First Line	:	PO BOX 159
Second Line	:
City	:	SAINT PAULS
State	:	NC
Zip	:	28384-0159
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	227 E 4TH AVE
Second Line	:
City	:	RED SPRINGS
State	:	NC
Zip	:	28377-1603
Country	:	US
Telephone Number	:	910-395-0021
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	THAD DAVIS
Credential	:
Telephone Number	:	910-865-3500

Provider Enumeration Date	:	02/23/2009
Last Update Date	:	02/23/2009

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