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General NPI Number Information
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NPI Number | 1770934689
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Entity Type | Organization
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Legal Business Name | 1ST CHOICE DRUG & TESTING SERVICES
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Dates
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Enumeration Date | 06/22/2016
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Last Update Date | 06/22/2016
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Provider Practice Location Address
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Address Line | 1217 GARY ST
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City | SHREVEPORT
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State | LA
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Zip | 71101-4323
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Country | US
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Telephone | 318-221-2407
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Fax | 318-221-2341
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Provider Business Mailing Address
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Address Line | 1217 GARY ST
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City | SHREVEPORT
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State | LA
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Zip | 71101-4323
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Country | US
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Telephone | 318-221-2407
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Fax | 318-221-2341
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Authorized Official
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Title or Position | C.E.O.
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Name | MR. DERRICK L HENDERSON
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Credential |
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Telephone | 318-221-2407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number |
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License Number State |
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