MEDICARE: FIRSTCHOICE HEALTHCARE PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1144576612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRSTCHOICE HEALTHCARE PC

Provider Business Mailing Address
First Line	:	1920 2ND LOOP RD
Second Line	:
City	:	FLORENCE
State	:	SC
Zip	:	29501-6123
Country	:	US
Telephone Number	:	843-678-9777
Fax Number	:	843-665-2814

Provider Business Practice Location Address
First Line	:	7021 SAINT ANDREWS RD
Second Line	:	SUITE 1
City	:	COLUMBIA
State	:	SC
Zip	:	29212-1177
Country	:	US
Telephone Number	:	803-749-7751
Fax Number	:	803-749-4060

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WILLIARD DEAN BANKS
Credential	:	D.C.
Telephone Number	:	843-678-9777

Provider Enumeration Date	:	08/02/2012
Last Update Date	:	08/27/2013

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Directions to “FIRSTCHOICE HEALTHCARE PC ” Practice Location

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