Healthcare Provider Details

I. General information

NPI: 1679503627
Provider Name (Legal Business Name): FIRST CHOICE FAMILY MEDICAL CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 MEDICAL BLVD SUITE 102
SPRING HILL FL
34609-0220
US

IV. Provider business mailing address

120 MEDICAL BLVD SUITE 102
SPRING HILL FL
34609-0221
US

V. Phone/Fax

Practice location:
  • Phone: 352-686-0086
  • Fax: 352-684-2081
Mailing address:
  • Phone: 352-686-0086
  • Fax: 352-684-2081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS8257
License Number StateFL

VIII. Authorized Official

Name: DR. BRIAN C KROLL
Title or Position: PRESIDENT
Credential: D.O.
Phone: 352-686-0086