MEDICARE: 1 ST CHOICE WELLNESS INC

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	261QP3300X	Pain Clinic/Center	HCC9465	FL

General Provider Information

NPI Number	:	1568718724
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1 ST CHOICE WELLNESS INC

Provider Business Mailing Address
First Line	:	5105 E COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-4385
Country	:	US
Telephone Number	:	407-440-2922
Fax Number	:	407-440-2963

Provider Business Practice Location Address
First Line	:	5105 E COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32803-4385
Country	:	US
Telephone Number	:	407-440-2922
Fax Number	:	407-440-2963

Authorized Official
Title or Position	:	PRESIDENT
Name	:	JOSEPH YOSSIFON
Credential	:
Telephone Number	:	407-440-2922

Provider Enumeration Date	:	07/25/2012
Last Update Date	:	07/25/2012

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Directions to “1 ST CHOICE WELLNESS INC ” Practice Location

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