Basic Information
| Provider Information | |||||||||
| NPI: | 1700164662 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | 1ST CHOICE MEDICAL GROUP PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 151186 | ||||||||
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| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761085186 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8172639700 | ||||||||
| FaxNumber: | 8172639706 | ||||||||
| Practice Location | |||||||||
| Address1: | 903 SUMMIT AVE | ||||||||
| Address2: | |||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761023421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8178775353 | ||||||||
| FaxNumber: | 8178775357 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2011 | ||||||||
| LastUpdateDate: | 07/26/2011 | ||||||||
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| AuthorizedOfficialLastName: | MEYER | ||||||||
| AuthorizedOfficialFirstName: | JASON | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8174562555 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.