Provider Demographics
NPI:1659313443
Name:1ST CHOICE HEALTHCARE LLC
Entity Type:Organization
Organization Name:1ST CHOICE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BERTONCINO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-673-8090
Mailing Address - Street 1:1107 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:WEBB CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64870-2831
Mailing Address - Country:US
Mailing Address - Phone:417-673-8090
Mailing Address - Fax:417-673-8222
Practice Address - Street 1:1107 S MADISON ST
Practice Address - Street 2:
Practice Address - City:WEBB CITY
Practice Address - State:MO
Practice Address - Zip Code:64870-2831
Practice Address - Country:US
Practice Address - Phone:417-673-8090
Practice Address - Fax:417-673-8222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
MO20020293063336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4634840001Medicare ID - Type UnspecifiedMEDICARE PROVIDER