Provider Demographics
NPI:1740203611
Name:FIRST CHOICE COMMUNITY HEALTH CENTERS
Entity Type:Organization
Organization Name:FIRST CHOICE COMMUNITY HEALTH CENTERS
Other - Org Name:BENHAVEN MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-364-0971
Mailing Address - Street 1:40 AUTUMN FERN TRL
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-5155
Mailing Address - Country:US
Mailing Address - Phone:910-364-0971
Mailing Address - Fax:910-814-4064
Practice Address - Street 1:985 NC 87 SOUTH
Practice Address - Street 2:
Practice Address - City:CAMERON
Practice Address - State:NC
Practice Address - Zip Code:28326
Practice Address - Country:US
Practice Address - Phone:919-499-9422
Practice Address - Fax:919-499-6752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2804101OtherMEDICARE PART B
NC344508AMedicaid
NC344508AMedicaid