Provider Demographics
NPI:1598982555
Name:FIRSTCARE MEDICAL CENTER
Entity Type:Organization
Organization Name:FIRSTCARE MEDICAL CENTER
Other - Org Name:FIRSTCARE MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IKENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ADUGBA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:940-384-1809
Mailing Address - Street 1:2185 BRINKER RD
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76208-6986
Mailing Address - Country:US
Mailing Address - Phone:940-384-1809
Mailing Address - Fax:940-384-7744
Practice Address - Street 1:2185 BRINKER RD
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76208-6986
Practice Address - Country:US
Practice Address - Phone:940-384-1809
Practice Address - Fax:940-384-7744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2013-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX131165611Medicaid
TX161797901Medicaid
TX00153VMedicare PIN
TX161797901Medicaid