Provider Demographics
NPI:1972759496
Name:FIRST CHOICE MEDICAL CENTER LLC
Entity type:Organization
Organization Name:FIRST CHOICE MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NASSER
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMBAZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:757-671-7777
Mailing Address - Street 1:4876 BAXTER ROAD
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462
Mailing Address - Country:US
Mailing Address - Phone:757-671-7777
Mailing Address - Fax:
Practice Address - Street 1:4876 BAXTER ROAD
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462
Practice Address - Country:US
Practice Address - Phone:757-671-7777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-15
Last Update Date:2015-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101037952207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5680255Medicaid
VA5680255Medicaid
VAB59656Medicare UPIN