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General NPI Number Information
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NPI Number | 1598817801
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Entity Type | Organization
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Legal Business Name | FIRST CHOICE NEUROSURGERY, PC
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 05/15/2013
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Provider Practice Location Address
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Address Line | 135 W RAVINE RD SUITE 4-A
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City | KINGSPORT
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State | TN
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Zip | 37660-3847
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Country | US
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Telephone | 423-392-9300
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Fax | 423-392-9365
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Provider Business Mailing Address
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Address Line | 135 W RAVINE RD SUITE 4-A
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City | KINGSPORT
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State | TN
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Zip | 37660-3847
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Country | US
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Telephone | 423-392-9300
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Fax | 423-392-9365
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Authorized Official
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Title or Position | OWNER
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Name | LAWRENCE P HARTMAN
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Credential | M.D.
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Telephone | 423-392-9300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WR0006X
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Taxonomy Name | Registered Nurse First Assistant
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License Number | 139176
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 36815
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 36815
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License Number State | TN
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