| 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 |