1881617850 NPI number — FIRST CHOICE COMMUNITY HEALTH CENTERS

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 1881617850 NPI number — FIRST CHOICE COMMUNITY HEALTH CENTERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FIRST CHOICE COMMUNITY HEALTH CENTERS
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:
1881617850
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
40 AUTUMN FERN TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LILLINGTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27546-5155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-364-0971
Provider Business Mailing Address Fax Number:
910-814-4064

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 MEDICAL CENTER ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAMERS
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27552-0397
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-893-3063
Provider Business Practice Location Address Fax Number:
910-897-2567
Provider Enumeration Date:
07/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SIMMONS
Authorized Official First Name:
SHEILA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
910-364-0971

Provider Taxonomy Codes

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

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

  • Identifier: 344509A , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2804129 . This is a "MEDICARE PART B" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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