MEDICARE: 1ST TOTAL HEALTH CARE

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	305S00000X	Point of Service

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	008499	OTHER	TX	LICENSED CERTIFIED HHS

General Provider Information

NPI Number	:	1942242680
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1ST TOTAL HEALTH CARE

Provider Business Mailing Address
First Line	:	3333 KNOLLCREST LN
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75181-2938
Country	:	US
Telephone Number	:	469-831-1960
Fax Number	:	972-222-6658

Provider Business Practice Location Address
First Line	:	3333 KNOLLCREST LN
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75181-2938
Country	:	US
Telephone Number	:	469-831-1960
Fax Number	:	972-222-6658

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. PETER EBERE
Credential	:
Telephone Number	:	469-831-1960

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	09/26/2012

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