Healthcare Provider Details

I. General information

NPI: 1457413999
Provider Name (Legal Business Name): FIRST CHOICE MEDICAL GROUP PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 09/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 E BROAD AVE
ROCKINGHAM NC
28379-4338
US

IV. Provider business mailing address

921 E BROAD AVE
ROCKINGHAM NC
28379-4338
US

V. Phone/Fax

Practice location:
  • Phone: 910-895-6042
  • Fax: 910-895-3199
Mailing address:
  • Phone: 910-895-6042
  • Fax: 910-895-3199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1885
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1825
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number26678
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number26479
License Number StateNC

VIII. Authorized Official

Name: LARRY E STOGNER
Title or Position: CFO
Credential: DC
Phone: 910-895-6042