MEDICARE: 1ST PRIORITY HEALTHCARE LLC

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	101YM0800X	Mental Health Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386255131
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1ST PRIORITY HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	1191 SALEM LAKE RD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27107-1550
Country	:	US
Telephone Number	:	336-413-8765
Fax Number	:	502-286-6565

Provider Business Practice Location Address
First Line	:	4229 BARDSTOWN RD STE 201
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40218-3286
Country	:	US
Telephone Number	:	502-286-6565
Fax Number	:	502-286-6565

Authorized Official
Title or Position	:	CEO
Name	:	SENECA G DAVIDSON
Credential	:
Telephone Number	:	336-413-8765

Provider Enumeration Date	:	08/14/2020
Last Update Date	:	02/07/2023

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