| Primary And Behavioral Healthcare Services, Pa | |
|
2252 Tower Dr Ste 108 Monroe LA 71201-5765 | |
| (769) 572-4009 | |
| (769) 572-4021 |
| Full Name | Primary And Behavioral Healthcare Services, Pa |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 2252 Tower Dr Ste 108, Monroe, Louisiana |
| Authorized Official Name and Position | Shameca L Hudson (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 7695724009 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Primary And Behavioral Healthcare Services, Pa 717 E. Fortification St. Jackson MS 39202-2402 Ph: (769) 572-4009 | Primary And Behavioral Healthcare Services, Pa 2252 Tower Dr Ste 108 Monroe LA 71201-5765 Ph: (769) 572-4009 |
| NPI Number | 1710545488 |
|---|---|
| Provider Enumeration Date | 05/29/2019 |
| Last Update Date | 11/10/2021 |
| Medicare PECOS PAC ID | 4486984796 |
|---|---|
| Medicare Enrollment ID | O20191001000120 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1710545488 | NPI | - | NPPES |
| 00000000 | Medicaid | MS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 363LP0808X | Nurse Practitioner - Psychiatric/mental Health | (* (Not Available)) | Primary |
| Provider Name | Shameca Hudson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1619362977 PECOS PAC ID: 7416265665 Enrollment ID: I20151007002887 |
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