NPIMap

Organization Active NPI

Southwest Louisiana Primary Health Care Center Inc

Doing business as Northside Community Health Center

  • Federally Qualified Health Center (FQHC)
  • Lafayette, LA
National Provider Identifier
1609120682
Registry record updated Apr 28, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
SOUTHWEST LOUISIANA PRIMARY HEALTH CARE CENTER INC
Doing business as
Northside Community Health Center
Practice address
1800 Louisiana Ave
Lafayette, LA 70501-3702
Phone
(337) 942-3390
Fax
(337) 942-8644
NPI assigned
Oct 30, 2012
Last updated
Apr 28, 2017By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dodie Lamott, C E O
Title
Executive Director
Phone
(337) 942-3390

Specialties & licenses 1

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

Addresses

Primary practice location

1800 Louisiana Ave
Lafayette, LA 70501-3702

Mailing address

PO Box 1815
Opelousas, LA 70571-1815
Phone (337) 942-3390

Other names 1

  • Northside Community Health Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in LA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170630001104 LA Part A Provider - Federally Qualified Health Center (FQHC) 8628987682 Practice locations: Lafayette, LA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1609120682. Details of each certification follow.

Federally qualified health center certification: CCN 191972

Legal name
SOUTHWEST LOUISIANA PRIMARY HEALTH CARE CENTER, INC
Doing business as
NORTHSIDE COMMUNITY HEALTH CENTER
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jun 30, 2017
Last certification
Jun 30, 2017
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Incorporated
Feb 1, 2014 in LA
Enrollment address
1800 Louisiana Ave
Lafayette, LA 70501-3702

Other NPIs with the same Medicare PAC ID 2

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

National Provider Directory

National Provider Directory
Tax ID family
SW Louisiana Primary He10 organizations share this tax ID, including this one

Other organizations with this tax ID 9

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

Ownership & related parties

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 Feb 1, 2014
Josie Frank Individual Corporate Director Feb 1, 2014
Dodie J Lamott Individual Corporate Director Feb 1, 2014
W-2 Managing EmployeeChief Executive Officer Feb 1, 2014
Mary T Guidry Individual Corporate Director Feb 1, 2014
Linda Prudhomme Individual Corporate Director Feb 1, 2014
Patrick J Leday Individual Corporate Director Feb 1, 2014
Sarah Carriere Individual Corporate Director Feb 1, 2014
Janel Simien Individual Corporate Director Feb 1, 2014

Owners & managing parties with NPI records 1

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

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 CenterOpelousas, LA, CCN 191817 Federally qualified health center Operational/Managerial Control Feb 1, 1993

Owned or controlled facilities with NPI records 1

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1351555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1493337600000",
    "number": "1609120682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1815",
            "city": "OPELOUSAS",
            "state": "LA",
            "postal_code": "705711815",
            "telephone_number": "337-942-3390",
            "fax_number": "337-942-8644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1800 LOUISIANA AVE",
            "city": "LAFAYETTE",
            "state": "LA",
            "postal_code": "705013702",
            "telephone_number": "337-942-3390",
            "fax_number": "337-942-8644"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHWEST LOUISIANA PRIMARY HEALTH CARE CENTER INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-30",
        "last_updated": "2017-04-28",
        "status": "A",
        "authorized_official_last_name": "LAMOTT",
        "authorized_official_first_name": "DODIE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "337-942-3390",
        "authorized_official_credential": "C E O"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Northside Community Health Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lafayette, LA

Sources for this page

Verify at the official NPI Registry.