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Southwest Louisiana Primary Health Care Center Inc

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

NPI 1609120682 · NPPES record last updated Apr 28, 2017

Key facts

NPI
1609120682
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
1800 Louisiana Ave
Lafayette, LA 70501-3702
Phone
(337) 942-3390
Fax
(337) 942-8644
NPI assigned
Oct 30, 2012
Organization subpart
No

Authorized official

Name
Dodie Lamott, C E O
Title
Executive Director
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 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 12

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 in LA

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
Corporation · Non-profit
Incorporated
Feb 1, 2014 in LA
Enrollment address
1800 Louisiana Ave
Lafayette, LA 70501-3702

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 Employee
Chief 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

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
O20170630001104 LA Part a Provider - Federally Qualified Health Center (FQHC) 8628987682 Practice locations: Lafayette, LA

National Provider Directory

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

Specialties & licenses

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

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

  • Northside Community Health Center Doing business as

Other providers in Lafayette, LA

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

Sources for this page

Verify at the official NPI Registry.