Healthcare Provider Details

I. General information

NPI: 1285176529
Provider Name (Legal Business Name): FIRST CHOICE MEDICAL AND GASTROENTEROLOGY ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 11/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 MIDDLEFORD RD
SEAFORD DE
19973-3604
US

IV. Provider business mailing address

904 MIDDLEFORD RD
SEAFORD DE
19973-3604
US

V. Phone/Fax

Practice location:
  • Phone: 302-629-5553
  • Fax: 302-536-7009
Mailing address:
  • Phone: 302-629-5553
  • Fax: 302-536-7009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberC10001972
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberLG0000610
License Number StateDE

VIII. Authorized Official

Name: MRS. VICKI HARDISTY
Title or Position: PRESIDENT
Credential: NP
Phone: 302-629-5553