FIRST CHOICE PHYSICIAN PARTNERS (GREATER MODESTO MEDICAL SURGICAL ASSOCIATES) - NPI NUMBER 1588921431

Summary

Provider Name: FIRST CHOICE PHYSICIAN PARTNERS (GREATER MODESTO MEDICAL SURGICAL ASSOCIATES)

NPI Number: 1588921431

Clasification: Thoracic Surgery (Cardiothoracic Vascular Surgery) (208G00000X)

Address:
1541 FLORIDA AVE
STE 103
MODESTO, CA
ZIP 95350

Phone Number: (209) 577-3388



Detailed Information

FIRST CHOICE PHYSICIAN PARTNERS is a thoracic surgeon in Modesto, CA. The provider is a thoracic surgeon provides the operative, perioperative and critical care of patients with pathologic conditions within the chest. Included is the surgical care of coronary artery disease, cancers of the lung, esophagus and chest wall, abnormalities of the trachea, abnormalities of the great vessels and heart valves, congenital anomalies, tumors of the mediastinum and diseases of the diaphragm. The management of the airway and injuries of the chest is within the scope of the specialty. The assigned NPI number for this provider is 1588921431 and is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Greater Modesto Medical Surgical Associates.

The provider's business address is:

1541 FLORIDA AVE
STE 103
MODESTO, CA
ZIP 95350-429
Phone: (209) 577-3388
Fax: (209) 523-0764

The provider's authorized official is Jeff Koury .
The authorized official title is Ceo and has the following contact phone number (714) 428-6842.

The enumeration date for this NPI number is 4/17/2012 and was last updated on 4/27/2012.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 208G00000X Thoracic Surgery (Cardiothoracic Vascular Surgery) Yes

NPI Record

No. Field Name Field Value
1 NPI 1588921431
2 Entity Type Code 2
3 Employer Identification Number EIN
4 Provider Organization Name Legal Business Name FIRST CHOICE PHYSICIAN PARTNERS
5 Provider Other Organization Name GREATER MODESTO MEDICAL SURGICAL ASSOCIATES
6 Provider Other Organization Name Type Code 3
7 Provider First Line Business Practice Location Address 1541 FLORIDA AVE
8 Provider Second Line Business Practice Location Address STE 103
9 Provider Business Practice Location Address City Name MODESTO
10 Provider Business Practice Location Address State Name CA
11 Provider Business Practice Location Address Postal Code 953504429
12 Provider Business Practice Location Address Country Code If outside U S US
13 Provider Business Practice Location Address Telephone Number 2095773388
14 Provider Business Practice Location Address Fax Number 2095230764
15 Provider Enumeration Date 4/17/2012
16 Last Update Date 4/27/2012
17 Authorized Official Last Name KOURY
18 Authorized Official First Name JEFF
19 Authorized Official Title or Position CEO
20 Authorized Official Telephone Number 7144286842
21 Healthcare Provider Taxonomy Code 1 208G00000X
22 Healthcare Provider Primary Taxonomy Switch 1 Y
23 Is Organization Subpart Y
24 Parent Organization LBN FIRST CHOICE PHYSICIAN PARTNERS
25 Parent Organization TIN
26 Authorized Official Name Prefix Text MR.
27 Healthcare Provider Taxonomy Group 1 193200000X MULTI-SPECIALTY GROUP

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This page was last updated on: 11/14/2014
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