Provider Demographics
NPI:1609120682
Name:SOUTHWEST LOUISIANA PRIMARY HEALTH CARE CENTER INC
Entity type:Organization
Organization Name:SOUTHWEST LOUISIANA PRIMARY HEALTH CARE CENTER INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DODIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMOTT
Authorized Official - Suffix:
Authorized Official - Credentials:C E O
Authorized Official - Phone:337-942-3390
Mailing Address - Street 1:PO BOX 1815
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70571-1815
Mailing Address - Country:US
Mailing Address - Phone:337-942-3390
Mailing Address - Fax:337-942-8644
Practice Address - Street 1:1800 LOUISIANA AVE
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70501-3702
Practice Address - Country:US
Practice Address - Phone:337-942-3390
Practice Address - Fax:337-942-8644
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-30
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)