Plaquemines Primary Care, Inc. | |
27136 Hwy 23 Suite A Port Sulphur LA 70083 | |
(504) 564-0848 | |
(504) 564-0849 |
Full Name | Plaquemines Primary Care, Inc. |
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Speciality | Clinic/Center |
Location | 27136 Hwy 23, Port Sulphur, Louisiana |
Authorized Official Name and Position | Leslie Prest (ADMINISTRATOR) |
Authorized Official Contact | 5045640848 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Plaquemines Primary Care, Inc. 27136 Hwy 23 Suite A Port Sulphur LA 70083 Ph: (504) 564-0848 | Plaquemines Primary Care, Inc. 27136 Hwy 23 Suite A Port Sulphur LA 70083 Ph: (504) 564-0848 |
NPI Number | 1407171721 |
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Provider Enumeration Date | 03/30/2010 |
Last Update Date | 01/03/2020 |
Medicare PECOS PAC ID | 4183755051 |
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Medicare Enrollment ID | O20100622000517 |
Identifier | Type | State | Issuer |
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1407171721 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
Provider Name | Michael D Kotler |
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Provider Type | Practitioner - Emergency Medicine |
Provider Identifiers | NPI Number: 1760473375 PECOS PAC ID: 6901822329 Enrollment ID: I20110308000525 |
Provider Name | Maria I Cartagena |
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Provider Type | Practitioner - Family Practice |
Provider Identifiers | NPI Number: 1811183627 PECOS PAC ID: 1254501158 Enrollment ID: I20110901000582 |
Provider Name | Annette Cotton |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1821542788 PECOS PAC ID: 0648554428 Enrollment ID: I20170222001130 |
Provider Name | John H Wells |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1265630685 PECOS PAC ID: 9931479292 Enrollment ID: I20170719000644 |
Provider Name | Shelly C Williams |
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Provider Type | Practitioner - Nurse Practitioner |
Provider Identifiers | NPI Number: 1538680822 PECOS PAC ID: 4082988167 Enrollment ID: I20170928001774 |
Provider Name | Jolisha S Eubanks-bradley |
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Provider Type | Practitioner - Obstetrics/gynecology |
Provider Identifiers | NPI Number: 1336567049 PECOS PAC ID: 3678792983 Enrollment ID: I20180823003466 |