1871043190 NPI number — CHOICE PAIN & REHABILITATION CENTER, LLC

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 1871043190 NPI number — CHOICE PAIN & REHABILITATION CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHOICE PAIN & REHABILITATION CENTER, 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:
CHOICE PAIN & REHABILITATION CENTER LLC
Provider Other Organization Name Type Code:
5
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:
1871043190
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/19/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8843 GREENBELT RD STE 117
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENBELT
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20770-2451
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-786-1001
Provider Business Mailing Address Fax Number:
240-786-1002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18540 OFFICE PARK DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTGOMERY VILLAGE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20886-0586
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-786-1001
Provider Business Practice Location Address Fax Number:
240-786-1002
Provider Enumeration Date:
10/11/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SHOCKLEY
Authorized Official First Name:
TRISTAN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
240-786-1001

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  D0068884 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com