Healthcare Provider Details

I. General information

NPI: 1740365113
Provider Name (Legal Business Name): PRIMARY HEALTH CHOICE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 02/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

219 W BROAD ST
SAINT PAULS NC
28384-1533
US

IV. Provider business mailing address

PO BOX 159
SAINT PAULS NC
28384-0159
US

V. Phone/Fax

Practice location:
  • Phone: 910-865-3500
  • Fax: 910-865-4124
Mailing address:
  • Phone: 910-865-3500
  • Fax: 910-865-4124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

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