Healthcare Provider Details

I. General information

NPI: 1316291495
Provider Name (Legal Business Name): PRIMARY HEALTH SERVICES CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2012
Last Update Date: 04/15/2021
Certification Date: 04/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2915 BETIN AVE
MONROE LA
71201-7257
US

IV. Provider business mailing address

PO BOX 7495
MONROE LA
71211-7495
US

V. Phone/Fax

Practice location:
  • Phone: 318-651-9945
  • Fax: 318-410-0680
Mailing address:
  • Phone: 318-388-1250
  • Fax: 318-388-0948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MRS. CATHERINE M. TONORE
Title or Position: CEO
Credential:
Phone: 318-388-1250