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	251S00000X	Community/Behavioral Health Agency
2	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1386824852
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PRIMARY HEALTH CHOICE, INC.

Provider Business Mailing Address
First Line	:	500 PETERSON DR
Second Line	:
City	:	LUMBERTON
State	:	NC
Zip	:	28358-2600
Country	:	US
Telephone Number	:	910-739-1445
Fax Number	:	910-739-1447

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	:	910-359-0021
Fax Number	:	910-359-0024

Authorized Official
Title or Position	:	OWNER/DIRECTOR
Name	:	MR. THAD DAVIS
Credential	:
Telephone Number	:	910-739-1445

Provider Enumeration Date	:	11/13/2007
Last Update Date	:	11/13/2007

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