Healthcare Provider Details

I. General information

NPI: 1679706691
Provider Name (Legal Business Name): FIRST CHOICE COMMUNITY HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2009
Last Update Date: 04/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MEDICAL CENTER ROAD HWY 421
MAMERS NC
27552-0397
US

IV. Provider business mailing address

40 AUTUMN FERN TRL
LILLINGTON NC
27546-5155
US

V. Phone/Fax

Practice location:
  • Phone: 910-893-5402
  • Fax: 910-893-2567
Mailing address:
  • Phone: 910-364-0971
  • Fax: 910-814-4064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: SHEILA SIMMONS
Title or Position: CEO
Credential:
Phone: 910-364-0971