Healthcare Provider Details

I. General information

NPI: 1417102906
Provider Name (Legal Business Name): FIRST CHOICE MEDICAL CARE OF MEDINA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/25/2008
Last Update Date: 11/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 HWY 45 EAST
MEDINA TN
38355
US

IV. Provider business mailing address

605 HWY 45 EAST P.O. BOX 159
MEDINA TN
38355
US

V. Phone/Fax

Practice location:
  • Phone: 731-267-0239
  • Fax:
Mailing address:
  • Phone: 731-267-0239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberRN33929
License Number StateTN

VIII. Authorized Official

Name: MRS. BETTY ROE
Title or Position: OWNER
Credential: FNP
Phone: 731-267-0239