1831837376 NPI number — FIRST CHOICE WELLNESS CENTERS, LLC

Table of content: (NPI 1831837376)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831837376 NPI number — FIRST CHOICE WELLNESS CENTERS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST CHOICE WELLNESS CENTERS, 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:
1831837376
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 COMMONS DR STE 101A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALLATIN
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37066-6331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
866-665-3244
Provider Business Mailing Address Fax Number:
844-461-3244

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
57 S COYLE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PENSACOLA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32502-5505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
850-604-8337
Provider Business Practice Location Address Fax Number:
844-461-3244
Provider Enumeration Date:
05/24/2022

Additional Information

Authorized Official

Authorized Official Last Name:
OSBORNE
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
866-665-3244

Provider Taxonomy Codes

  • Taxonomy code: 261QI0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 117750800 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001167755 . This is a "TN SEC OF STATE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 117750800 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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