Healthcare Provider Details

I. General information

NPI: 1295817211
Provider Name (Legal Business Name): PRIMARY HEALTH CHOICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 04/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 S 5TH ST STE B
SAINT PAULS NC
28384-1573
US

IV. Provider business mailing address

PO BOX 159
SAINT PAULS NC
28384-0159
US

V. Phone/Fax

Practice location:
  • Phone: 910-865-8280
  • Fax: 910-865-8281
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. THAD J DAVIS
Title or Position: DIRECTOR
Credential:
Phone: 910-865-3500