Provider Demographics
NPI:1790057446
Name:FIRSTCHOICE HEALTHCARE PC
Entity Type:Organization
Organization Name:FIRSTCHOICE HEALTHCARE PC
Other - Org Name:THE PAIN CENTER OF FIRSTCHOICE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLARD
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:BANKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-678-9777
Mailing Address - Street 1:1920 2ND LOOP RD
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-6123
Mailing Address - Country:US
Mailing Address - Phone:843-678-9777
Mailing Address - Fax:843-665-2814
Practice Address - Street 1:40 OKATIE CENTER BLVD S
Practice Address - Street 2:SUITE 350
Practice Address - City:OKATIE
Practice Address - State:SC
Practice Address - Zip Code:29909-7507
Practice Address - Country:US
Practice Address - Phone:843-705-3800
Practice Address - Fax:843-705-3840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-27
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC13361207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC13361OtherBUSINESS LICENSE