Provider Demographics
NPI:1457413999
Name:FIRST CHOICE MEDICAL GROUP PC
Entity type:Organization
Organization Name:FIRST CHOICE MEDICAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:STOGNER
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:910-895-6042
Mailing Address - Street 1:921 E BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-4338
Mailing Address - Country:US
Mailing Address - Phone:910-895-6042
Mailing Address - Fax:910-895-3199
Practice Address - Street 1:921 E BROAD AVE
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-4338
Practice Address - Country:US
Practice Address - Phone:910-895-6042
Practice Address - Fax:910-895-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1885111N00000X
NC1825111N00000X
NC26678208D00000X
NC26479207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5908886Medicaid
NC5908886Medicaid
NCCJ6007Medicare PIN
NC2344608Medicare PIN