1811976814 NPI number — FIRST CHOICE HOME MEDICAL SUPPLIES, LLC

Table of content: (NPI 1811976814)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811976814 NPI number — FIRST CHOICE HOME MEDICAL SUPPLIES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST CHOICE HOME MEDICAL SUPPLIES, 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:
1811976814
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 W MADISON AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ATHENS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37303-3427
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-745-5208
Provider Business Mailing Address Fax Number:
423-745-5574

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 W MADISON AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATHENS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37303-3427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-745-5208
Provider Business Practice Location Address Fax Number:
423-745-5574
Provider Enumeration Date:
01/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DILLON
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CHIEF MANAGER
Authorized Official Telephone Number:
423-745-5208

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0000000653 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1922898 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3533493 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 433207 . This is a "TRIGON" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 100023725 . This is a "CARITEN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 0810704 . This is a "CIGNA" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: COFS3921082 . This is a "CHAMPUS" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 002009743 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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