Provider Demographics
NPI:1164015327
Name:FIRST CHOICE WELLNESS CENTERS, LLC
Entity Type:Organization
Organization Name:FIRST CHOICE WELLNESS CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DUANE
Authorized Official - Last Name:OSBORNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-562-3244
Mailing Address - Street 1:600 COMMONS DR STE 101A
Mailing Address - Street 2:
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-6331
Mailing Address - Country:US
Mailing Address - Phone:866-665-3244
Mailing Address - Fax:844-324-3244
Practice Address - Street 1:600 COMMONS DR STE 101A
Practice Address - Street 2:
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-6331
Practice Address - Country:US
Practice Address - Phone:866-665-3244
Practice Address - Fax:844-324-3244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-18
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ071941Medicaid
TN001167755OtherTN SEC OF STATE