MEDICARE: FIRST CHOICE PERSONAL INJURY CLINIC, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center	HCC6040	FL

General Provider Information

NPI Number	:	1558583112
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST CHOICE PERSONAL INJURY CLINIC, INC.

Provider Business Mailing Address
First Line	:	2916 W WATERS AVE
Second Line	:	STE A-2
City	:	TAMPA
State	:	FL
Zip	:	33614
Country	:	US
Telephone Number	:	813-931-1750
Fax Number	:	813-931-1757

Provider Business Practice Location Address
First Line	:	2916 W WATERS AVE
Second Line	:	STE A-2
City	:	TAMPA
State	:	FL
Zip	:	33614
Country	:	US
Telephone Number	:	813-931-1750
Fax Number	:	813-931-1757

Authorized Official
Title or Position	:	BILLING DEPARTMENT
Name	:	MR. DAVID QUINONES
Credential	:
Telephone Number	:	813-931-1750

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	08/22/2020

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