Provider Demographics
NPI:1912431818
Name:1ST CHOICE HEALTHCARE INC
Entity type:Organization
Organization Name:1ST CHOICE HEALTHCARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-857-3334
Mailing Address - Street 1:PO BOX 83
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:AR
Mailing Address - Zip Code:72422-0083
Mailing Address - Country:US
Mailing Address - Phone:870-857-3334
Mailing Address - Fax:870-857-9934
Practice Address - Street 1:172 HIGHWAY 62 W
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:AR
Practice Address - Zip Code:72576-8059
Practice Address - Country:US
Practice Address - Phone:870-895-2735
Practice Address - Fax:870-895-2709
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1ST CHOICE HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-04-18
Last Update Date:2024-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR220551749Medicaid