1881840437 NPI number — CHOICE MEDICAL SUPPLY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881840437 NPI number — CHOICE MEDICAL SUPPLY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHOICE MEDICAL SUPPLY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881840437
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1705 HWY 1431 WEST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARBLE FALLS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78654
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-798-9248
Provider Business Mailing Address Fax Number:
830-798-9249

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17 WINDMILL CIR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ABILENE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79606-5234
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-677-2250
Provider Business Practice Location Address Fax Number:
325-677-2124
Provider Enumeration Date:
08/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ALTMAN
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
M
Authorized Official Title or Position:
CONTRACT COORDINATOR
Authorized Official Telephone Number:
325-677-2250

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 157888202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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