1184617094 NPI number — FIRST CHOICE MEDICAL SUPPLY INC

Table of content: (NPI 1184617094)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184617094 NPI number — FIRST CHOICE MEDICAL SUPPLY INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST CHOICE MEDICAL SUPPLY 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:
1184617094
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 66
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CANFIELD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44406-0066
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-759-2603
Provider Business Mailing Address Fax Number:
330-759-2569

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4451 MAHONING AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44483-1977
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-847-0919
Provider Business Practice Location Address Fax Number:
330-847-0728
Provider Enumeration Date:
08/25/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ARFARAS
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
W
Authorized Official Title or Position:
OWNER/ADMINISTRATOR
Authorized Official Telephone Number:
330-759-2603

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 000000354979 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 1065329 . This is a "WV WORK COMP" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".
  • Identifier: 1679773 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2532272 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6058960000 . This is a "OWCP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1012276200001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".




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