| 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. | 
|---|---|
| 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 | 
|---|---|
| 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 | 
|---|---|
| Provider Enumeration Date | 03/30/2010 | 
| Last Update Date | 01/03/2020 | 
| Medicare PECOS PAC ID | 4183755051 | 
|---|---|
| Medicare Enrollment ID | O20100622000517 | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1407171721 | NPI | - | NPPES | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary | 
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary | 
| Provider Name | Michael D Kotler | 
|---|---|
| Provider Type | Practitioner - Emergency Medicine | 
| Provider Identifiers | NPI Number: 1760473375 PECOS PAC ID: 6901822329 Enrollment ID: I20110308000525  | 
| Provider Name | Maria I Cartagena | 
|---|---|
| Provider Type | Practitioner - Family Practice | 
| Provider Identifiers | NPI Number: 1811183627 PECOS PAC ID: 1254501158 Enrollment ID: I20110901000582  | 
| Provider Name | Annette Cotton | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1821542788 PECOS PAC ID: 0648554428 Enrollment ID: I20170222001130  | 
| Provider Name | John H Wells | 
|---|---|
| Provider Type | Practitioner - Psychiatry | 
| Provider Identifiers | NPI Number: 1265630685 PECOS PAC ID: 9931479292 Enrollment ID: I20170719000644  | 
| Provider Name | Shelly Williams | 
|---|---|
| Provider Type | Practitioner - Nurse Practitioner | 
| Provider Identifiers | NPI Number: 1538680822 PECOS PAC ID: 4082988167 Enrollment ID: I20170928001774  | 
| Provider Name | Jolisha S Eubanks-bradley | 
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology | 
| Provider Identifiers | NPI Number: 1336567049 PECOS PAC ID: 3678792983 Enrollment ID: I20180823003466  |