1245502616 NPI number — FIRST CHOICE OCCUPATIONAL HEALTH, LLC.

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 1245502616 NPI number — FIRST CHOICE OCCUPATIONAL HEALTH, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST CHOICE OCCUPATIONAL HEALTH, 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:
6
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:
1245502616
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1971 GOWDEY RD
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
NAPERVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60563-4232
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-416-7293
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1971 GOWDEY RD
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
NAPERVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60563-4232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-416-7293
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2012

Additional Information

Authorized Official

Authorized Official Last Name:
DAGHFAL
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
DANIEL
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
630-416-1300

Provider Taxonomy Codes

  • Taxonomy code: 261QX0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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