Provider Demographics
NPI:1740310234
Name:FIRST CHOICE HOME MEDICAL SUPPLIES, LLC
Entity type:Organization
Organization Name:FIRST CHOICE HOME MEDICAL SUPPLIES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SALES MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:CRUTCHFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-499-6242
Mailing Address - Street 1:701 W MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TN
Mailing Address - Zip Code:37303-3427
Mailing Address - Country:US
Mailing Address - Phone:423-745-5208
Mailing Address - Fax:
Practice Address - Street 1:5959 SHALLOWFORD RD STE 535
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-2253
Practice Address - Country:US
Practice Address - Phone:423-499-6242
Practice Address - Fax:423-499-6240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000653332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN002009743OtherBLUE CROSS BLUE SHIELD
TN0810704OtherCIGNA
TN1922898OtherUNITED HEALTHCARE
TN3533493Medicaid
TN100023725OtherCARITEN
TNCOFS3921082OtherCHAMPUS
TN433207OtherTRIGON
TN433207OtherTRIGON