Provider Demographics
NPI:1770934689
Name:1ST CHOICE DRUG & TESTING SERVICES
Entity type:Organization
Organization Name:1ST CHOICE DRUG & TESTING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:DERRICK
Authorized Official - Middle Name:L
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-221-2407
Mailing Address - Street 1:1217 GARY ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71101-4323
Mailing Address - Country:US
Mailing Address - Phone:318-221-2407
Mailing Address - Fax:318-221-2341
Practice Address - Street 1:1217 GARY ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71101-4323
Practice Address - Country:US
Practice Address - Phone:318-221-2407
Practice Address - Fax:318-221-2341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service