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 Field Definition 1
1 NPI 1588921431 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name FIRST CHOICE PHYSICIAN PARTNERS The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider Other Organization Name GREATER MODESTO MEDICAL SURGICAL ASSOCIATES Other name by which the organization provider is or has been known.
6 Provider Other Organization Name Type Code 3 Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
7 Provider First Line Business Practice Location Address 1541 FLORIDA AVE The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
8 Provider Second Line Business Practice Location Address STE 103 The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
9 Provider Business Practice Location Address City Name MODESTO The city name in the location address of the provider being identified.
10 Provider Business Practice Location Address State Name CA The State code in the location of the provider being identified.
11 Provider Business Practice Location Address Postal Code 953504429 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
12 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
13 Provider Business Practice Location Address Telephone Number 2095773388 The telephone number associated with the location address of the provider being identified.
14 Provider Business Practice Location Address Fax Number 2095230764 The fax number associated with the location address of the provider being identified.
15 Provider Enumeration Date 4/17/2012 The date the provider was assigned a unique identifier (assigned an NPI).
16 Last Update Date 4/27/2012 The date that a record was last updated or changed.
17 Authorized Official Last Name KOURY The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
18 Authorized Official First Name JEFF The first name of the authorized official.
19 Authorized Official Title or Position CEO The title or position of the authorized official.
20 Authorized Official Telephone Number 7144286842 The 10-position telephone number of the authorized official.
21 Healthcare Provider Taxonomy Code 1 208G00000X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
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: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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