Provider Demographics
NPI:1982629796
Name:FIRST CHOICE ORTHOTICS & PROSTHETICS INC.
Entity Type:Organization
Organization Name:FIRST CHOICE ORTHOTICS & PROSTHETICS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO /PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:CPO FAAOP
Authorized Official - Phone:601-502-2222
Mailing Address - Street 1:PO BOX 7384
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39282-7384
Mailing Address - Country:US
Mailing Address - Phone:601-502-2222
Mailing Address - Fax:601-502-2244
Practice Address - Street 1:1717 RAYMOND RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-4125
Practice Address - Country:US
Practice Address - Phone:601-502-2222
Practice Address - Fax:601-502-2244
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS025383878332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00440869Medicaid
MS00440869Medicaid