MEDICARE: 1ST CHOICE THERAPEUTICS, 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	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
2	253Z00000X	In Home Supportive Care Agency	16843601	PA

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	:	1770766891
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1ST CHOICE THERAPEUTICS, LLC

Provider Business Mailing Address
First Line	:	231 NORTHERN BLVD
Second Line	:	SUITE A
City	:	SOUTH ABINGTON TOWNSHIP
State	:	PA
Zip	:	18411-9189
Country	:	US
Telephone Number	:	570-587-4700
Fax Number	:

Provider Business Practice Location Address
First Line	:	231 NORTHERN BLVD
Second Line	:	SUITE A
City	:	SOUTH ABINGTON TOWNSHIP
State	:	PA
Zip	:	18411-9189
Country	:	US
Telephone Number	:	570-587-4700
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. KENNETH STEWART
Credential	:
Telephone Number	:	570-587-4700

Provider Enumeration Date	:	12/12/2007
Last Update Date	:	01/27/2014

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