Healthcare Provider Details

I. General information

NPI: 1679243117
Provider Name (Legal Business Name): 1ST CHOICE HEARING BENEFITS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2021
Last Update Date: 11/15/2023
Certification Date: 11/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 VALENCIA ST
PONTE VEDRA BEACH FL
32082-2834
US

IV. Provider business mailing address

PO BOX 2345
PONTE VEDRA FL
32004-2345
US

V. Phone/Fax

Practice location:
  • Phone: 888-614-0044
  • Fax: 866-476-0861
Mailing address:
  • Phone: 888-614-0044
  • Fax: 866-476-0861

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License Number
License Number State

VIII. Authorized Official

Name: AMBER JACKSON
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 888-614-0044