Provider Demographics
NPI:1275534778
Name:FIRST CHOICE HOME MEDICAL LLC
Entity Type:Organization
Organization Name:FIRST CHOICE HOME MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:THAD
Authorized Official - Middle Name:F
Authorized Official - Last Name:CONNALLY
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:270-393-9393
Mailing Address - Street 1:PO BOX 51485
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-5785
Mailing Address - Country:US
Mailing Address - Phone:270-393-9393
Mailing Address - Fax:270-393-9383
Practice Address - Street 1:830 FAIRVIEW AVE STE B5
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-4912
Practice Address - Country:US
Practice Address - Phone:270-393-9393
Practice Address - Fax:270-393-9383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-09
Last Update Date:2020-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY108684-000332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90006008Medicaid
KY90006008Medicaid