MEDICARE: 1ST CHOICE DRUG & TESTING SERVICES

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	305S00000X	Point of Service

General Provider Information

NPI Number	:	1770934689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1ST CHOICE DRUG & TESTING SERVICES

Provider Business Mailing Address
First Line	:	1217 GARY ST
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71101-4323
Country	:	US
Telephone Number	:	318-221-2407
Fax Number	:	318-221-2341

Provider Business Practice Location Address
First Line	:	1217 GARY ST
Second Line	:
City	:	SHREVEPORT
State	:	LA
Zip	:	71101-4323
Country	:	US
Telephone Number	:	318-221-2407
Fax Number	:	318-221-2341

Authorized Official
Title or Position	:	C.E.O.
Name	:	MR. DERRICK L HENDERSON
Credential	:
Telephone Number	:	318-221-2407

Provider Enumeration Date	:	06/22/2016
Last Update Date	:	06/22/2016

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