Healthcare Provider Details

I. General information

NPI: 1659313443
Provider Name (Legal Business Name): 1ST CHOICE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 S MADISON ST
WEBB CITY MO
64870-2831
US

IV. Provider business mailing address

1107 S MADISON ST
WEBB CITY MO
64870-2831
US

V. Phone/Fax

Practice location:
  • Phone: 417-673-8090
  • Fax: 417-673-8222
Mailing address:
  • Phone: 417-673-8090
  • Fax: 417-673-8222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number2002029306
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELIZABETH ANN BERTONCINO
Title or Position: OWNER
Credential:
Phone: 417-673-8090