Provider Demographics
NPI:1104064914
Name:FIRSTCHOICE HEALTHCARE, PC
Entity type:Organization
Organization Name:FIRSTCHOICE HEALTHCARE, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:W
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:843-678-9777
Mailing Address - Street 1:1920 SECOND LOOP RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-6123
Mailing Address - Country:US
Mailing Address - Phone:843-678-9777
Mailing Address - Fax:843-665-2814
Practice Address - Street 1:10 MILLER RD
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150-2403
Practice Address - Country:US
Practice Address - Phone:803-774-6500
Practice Address - Fax:803-774-4567
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-02
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6204620006Medicare NSC