Provider Demographics
NPI:1366498735
Name:1ST CHOICE HEALTHCARE INC
Entity Type:Organization
Organization Name:1ST CHOICE HEALTHCARE INC
Other - Org Name:1ST CHOICE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:STEVENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-857-3334
Mailing Address - Street 1:PO BOX 83
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:AR
Mailing Address - Zip Code:72422-0083
Mailing Address - Country:US
Mailing Address - Phone:870-857-3334
Mailing Address - Fax:870-857-9934
Practice Address - Street 1:1016 MCQUAY AVE
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:AR
Practice Address - Zip Code:72422
Practice Address - Country:US
Practice Address - Phone:870-892-9949
Practice Address - Fax:870-892-0208
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:1ST CHOICE HEALTHCARE, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-26
Last Update Date:2023-12-14
Deactivation Date:2006-06-09
Deactivation Code:
Reactivation Date:2006-06-09
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5B451OtherAR BCBS PROVIDER NUMBER
AR139315749Medicaid
MO504849605Medicaid
041840Medicare Oscar/Certification