Provider Demographics
NPI:1184838245
Name:FIRST CHOICE NEUROSURGERY
Entity Type:Organization
Organization Name:FIRST CHOICE NEUROSURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:P
Authorized Official - Last Name:HARTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:423-392-9300
Mailing Address - Street 1:135 W RAVINE RD
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3847
Mailing Address - Country:US
Mailing Address - Phone:423-392-9300
Mailing Address - Fax:423-392-9365
Practice Address - Street 1:438 E VANN RD
Practice Address - Street 2:SUITE 301
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37743-7202
Practice Address - Country:US
Practice Address - Phone:423-392-9300
Practice Address - Fax:423-392-9365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN139176163WR0006X
TN36815261QM2500X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No163WR0006XNursing Service ProvidersRegistered NurseRegistered Nurse First AssistantGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5803430001OtherDME NUMBER
TN3729788Medicaid
TN4205736OtherAETNA
KY64059660Medicaid
TN4103830OtherBC BS
VA177322OtherANTHEM
TN9454636OtherCIGNA
VA177322OtherANTHEM
TN9454636OtherCIGNA
VA177322OtherANTHEM
TNDD3260Medicare ID - Type UnspecifiedRAILROAD MEDICARE