# AMBEAUX PROFESSIONAL MGMT SER LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PrimeCare Health System
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699751180
- **Authorized official:** MR. LOUIS IRVIN AMBEAUX JR. PA (PHYSICIAN ASSISTANT SUPERVISOR)
- **Authorized official phone:** (936) 328-8944

## Contact information

- **Practice address:** 604 S WASHINGTON ST, LIVINGSTON, TX 77351-2074
- **Practice address phone:** (936) 328-8944
- **Practice address fax:** (936) 328-8945
- **Mailing address:** PO BOX 2074, LIVINGSTON, TX 77351-2074
- **Mailing address phone:** (936) 328-8944
- **Mailing address fax:** (936) 328-8945

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | PA01279 | TX | Yes |

## Other

- **Enumeration date:** 12/16/2005
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 00664R | MC - GROUP \# | — |