Organization
AMBEAUX PROFESSIONAL MGMT SER LLC
Active
Other names
PrimeCare Health System
Organization subpart
No
Provider details
NPI number
Authorized official
MR. LOUIS IRVIN AMBEAUX JR. PA (PHYSICIAN ASSISTANT SUPERVISOR)
(936) 328-8944
Entity
Organization
Contact information
Practice address
604 S WASHINGTON ST, LIVINGSTON, TX 77351-2074
(936) 328-8944
(936) 328-8945
Mailing address
PO BOX 2074, LIVINGSTON, TX 77351-2074
(936) 328-8944
(936) 328-8945
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
PA01279
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00664R
MC - GROUP #
—
Enumeration date
12/16/2005
Last updated
08/22/2020
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