Healthcare Provider Details

I. General information

NPI: 1982629796
Provider Name (Legal Business Name): FIRST CHOICE ORTHOTICS & PROSTHETICS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 11/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 RAYMOND RD
JACKSON MS
39204-4125
US

IV. Provider business mailing address

PO BOX 7384
JACKSON MS
39282-7384
US

V. Phone/Fax

Practice location:
  • Phone: 601-502-2222
  • Fax: 601-502-2244
Mailing address:
  • Phone: 601-502-2222
  • Fax: 601-502-2244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number025383878
License Number StateMS

VIII. Authorized Official

Name: MR. CHARLES WILLIAMS
Title or Position: CEO /PRESIDENT
Credential: CPO FAAOP
Phone: 601-502-2222