1730596693 NPI number — FIRST CHOICE HEALTHCARE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730596693 NPI number — FIRST CHOICE HEALTHCARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST CHOICE HEALTHCARE, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730596693
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12400 W OVERLAND RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
BOISE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83709-0021
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-322-7061
Provider Business Mailing Address Fax Number:
208-321-7052

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12400 W OVERLAND RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83709-0021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-322-7061
Provider Business Practice Location Address Fax Number:
208-321-7052
Provider Enumeration Date:
07/11/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CRAIG
Authorized Official First Name:
KARA
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
208-322-7061

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)