Provider Demographics
NPI:1942242680
Name:1ST TOTAL HEALTH CARE
Entity Type:Organization
Organization Name:1ST TOTAL HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:EBERE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-831-1960
Mailing Address - Street 1:3333 KNOLLCREST LN
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75181-2938
Mailing Address - Country:US
Mailing Address - Phone:469-831-1960
Mailing Address - Fax:972-222-6658
Practice Address - Street 1:3333 KNOLLCREST LN
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75181-2938
Practice Address - Country:US
Practice Address - Phone:469-831-1960
Practice Address - Fax:972-222-6658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-10
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX008499OtherLICENSED CERTIFIED HHS
679464Medicare ID - Type Unspecified