Provider Demographics
NPI:1629848908
Name:FIRST CARE CLINIC LLC
Entity Type:Organization
Organization Name:FIRST CARE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ARNP
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:HAM
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:850-718-7202
Mailing Address - Street 1:409 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:CHATTAHOOCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:32324-1303
Mailing Address - Country:US
Mailing Address - Phone:850-793-1100
Mailing Address - Fax:850-793-1102
Practice Address - Street 1:409 HIGH ST
Practice Address - Street 2:
Practice Address - City:CHATTAHOOCHEE
Practice Address - State:FL
Practice Address - Zip Code:32324-1303
Practice Address - Country:US
Practice Address - Phone:850-793-1100
Practice Address - Fax:850-793-1102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty