Healthcare Provider Details

I. General information

NPI: 1598817801
Provider Name (Legal Business Name): FIRST CHOICE NEUROSURGERY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 05/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 W RAVINE RD SUITE 4-A
KINGSPORT TN
37660-3847
US

IV. Provider business mailing address

135 W RAVINE RD SUITE 4-A
KINGSPORT TN
37660-3847
US

V. Phone/Fax

Practice location:
  • Phone: 423-392-9300
  • Fax: 423-392-9365
Mailing address:
  • Phone: 423-392-9300
  • Fax: 423-392-9365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number139176
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number36815
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number36815
License Number StateTN

VIII. Authorized Official

Name: LAWRENCE P HARTMAN
Title or Position: OWNER
Credential: M.D.
Phone: 423-392-9300