1043459779 NPI number — 1ST CHOICE HEALTHCARE SERVICES, LLC.

Table of content: (NPI 1043459779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043459779 NPI number — 1ST CHOICE HEALTHCARE SERVICES, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
1ST CHOICE HEALTHCARE SERVICES, LLC.
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:
1043459779
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
705 INGRAHAM AVE
Provider Second Line Business Mailing Address:
SUITE 8
Provider Business Mailing Address City Name:
HAINES CITY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33844-4327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-422-3600
Provider Business Mailing Address Fax Number:
863-422-4380

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
705 INGRAHAM AVE
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
HAINES CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33844-4327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-422-3600
Provider Business Practice Location Address Fax Number:
863-422-4380
Provider Enumeration Date:
02/19/2009

Additional Information

Authorized Official

Authorized Official Last Name:
VALLE
Authorized Official First Name:
FRANCISCO
Authorized Official Middle Name:
ESTEBAN
Authorized Official Title or Position:
ADMINISTRATOR/PRESIDENT
Authorized Official Telephone Number:
863-422-3600

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X , with the licence number: 299993417 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com