1821192170 NPI number — FIRSTCHOICE HEATLHCARE, PC

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 1821192170 NPI number — FIRSTCHOICE HEATLHCARE, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRSTCHOICE HEATLHCARE, PC
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:
1821192170
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1920 2ND LOOP RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLORENCE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29501-6123
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-678-9777
Provider Business Mailing Address Fax Number:
843-665-2814

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 W CAROLINA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARTSVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29550-4524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-857-0202
Provider Business Practice Location Address Fax Number:
843-857-0208
Provider Enumeration Date:
09/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARRINGTON
Authorized Official First Name:
STEPHANIE
Authorized Official Middle Name:
T
Authorized Official Title or Position:
CREDENTIALING CLERK
Authorized Official Telephone Number:
843-678-9777

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GP2339 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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