Healthcare Provider Details

I. General information

NPI: 1639559958
Provider Name (Legal Business Name): PRIMARY CARE PROVIDERS FOR A HEALTHY FELICIANA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 01/28/2021
Certification Date: 01/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27124 HWY 42
SPRINGFIELD LA
70462-7979
US

IV. Provider business mailing address

PO BOX 395
CLINTON LA
70722-0395
US

V. Phone/Fax

Practice location:
  • Phone: 225-395-8022
  • Fax: 225-395-8023
Mailing address:
  • Phone: 225-683-5292
  • Fax: 225-683-3411

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: GINGER A HUNT
Title or Position: CEO
Credential: APRN
Phone: 225-383-5292