1730163981 NPI number — CHOICE MEDICAL HEALTHCARE LLC

Table of content: (NPI 1730163981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730163981 NPI number — CHOICE MEDICAL HEALTHCARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHOICE MEDICAL HEALTHCARE LLC
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:
1730163981
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 W GERMANTOWN PIKE STE 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLYMOUTH MEETING
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19462-1437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-409-8741
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
56 E BROADWAY STE 600
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALT LAKE CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84111-2211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-386-5806
Provider Business Practice Location Address Fax Number:
801-904-3916
Provider Enumeration Date:
12/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GRIGGS
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
407-206-0040

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  203-000470 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 8174000-1714 , registered in the state of UT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 117529 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200497500A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 026548900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1730163981 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7657000 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200656190A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 428882 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1025841900 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1730163981 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1730163981/MCS008004 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 260053974-00 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1730163981 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2002587470A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3810017856 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3144823 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4800352 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1730163981 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1730163981 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100107510 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 722389 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".




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