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Southwest Louisiana Primary Health Care Center Inc

Organization Active NPI Federally Qualified Health Center (FQHC) · Ville Platte, LA

NPI 1003042698 · NPPES record last updated Oct 29, 2018

Key facts

NPI
1003042698
Entity type
Organization (NPI type 2)
Primary specialty
Federally Qualified Health Center (FQHC) 261QF0400X
Legal business name
SOUTHWEST LOUISIANA PRIMARY HEALTH CARE CENTER INC
Practice address
505 E Lincoln Rd
Ville Platte, LA 70586-3514
Phone
(337) 942-3390
Fax
(337) 942-8644
NPI assigned
Jun 9, 2009
Organization subpart
No

Authorized official

Name
Mrs. Dodie Lamott, CEO
Title
Chief Executive Officer
Phone
(337) 942-3390

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

  • Patrick Leday, CRNA Certified Registered Nurse Anesthetist · Ville Platte, LA · NPI 1649247149
    CMS ownership CORPORATE DIRECTOR

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 5

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled (2 enrollments) in LA

Federally qualified health center certification: CCN 191008

Legal name
SOUTHWEST LOUISIANA PRIMARY HEALTH CARE CENTER, INC
Doing business as
EVANGELINE FAMILY MEDICINE CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Nov 30, 2018
Last certification
Nov 30, 2018
Ownership / control type
For profit – corporation
Organization structure
Corporation · Non-profit
Incorporated
Jun 1, 2013 in LA
Enrollment address
505 E Lincoln Rd
Ville Platte, LA 70586-3514

All disclosed owners & managing parties 8

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Lonnie Fontenot
Individual 		Corporate Director
Director		 Jun 1, 2013
Josie Frank
Individual 		Corporate Director
Board of Directors - Vice President		 Jun 1, 2013
Dodie J Lamott
Individual 		Corporate Officer
Chief Executive Officer		 Jun 1, 2013
W-2 Managing Employee
Chief Executive Officer		 Jun 1, 2013
Mary T Guidry
Individual 		Corporate Director
Board of Directors - Member		 Jun 1, 2013
Linda Prudhomme
Individual 		Corporate Director
Board of Directors - Secretary		 Jun 1, 2013
Patrick J Leday
Individual 		Corporate Director
Board of Directors - President		 Jun 1, 2013
Sarah Carriere
Individual 		Corporate Director
Board of Directors - Treasure		 Jun 1, 2013
Janel Simien
Individual 		Corporate Director
Board of Directors - Member		 Jun 1, 2013

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Southwest Louisiana Primary Health Care Center
Opelousas, LA · CCN 191817		 Federally qualified health center Operational/Managerial Control Feb 1, 1993

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20041214000920 LA Part B Supplier - Clinic/Group Practice 8628987682 Receives reassigned benefits from 4 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ville Platte, LA
O20181130002328 LA Part a Provider - Federally Qualified Health Center (FQHC) 8628987682 Practice locations: Ville Platte, LA

National Provider Directory

Tax ID family
Southwest la Primary Ca (6 organizations share this tax ID)

Locations

110 E Lincoln Rd
Ville Platte, LA 70586
Phone (337) 942-3390

505 E Lincoln Rd
Ville Platte, LA 70586
Phone (337) 363-0604

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/BEIHAA

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X LA Yes
Federally Qualified Health Center (FQHC) 261QF0400X

Addresses

Primary practice location

505 E Lincoln Rd
Ville Platte, LA 70586-3514

Mailing address

8762 Highway 182
Opelousas, LA 70570-5603
Phone (337) 942-3390

Other names

  • EVANGELINE FAMILY MEDICINE CENTER Doing business as

Other providers in Ville Platte, LA

All providers in Ville Platte, LA · Federally Qualified Health Center (FQHC) in Louisiana

Sources for this page

Verify at the official NPI Registry.