Provider Demographics
NPI:1588402838
Name:PRIORITY CHOICE MEDICAL
Entity type:Organization
Organization Name:PRIORITY CHOICE MEDICAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LINCOLN
Authorized Official - Middle Name:
Authorized Official - Last Name:COFFIE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:254-498-1503
Mailing Address - Street 1:4907 DEERWOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-5793
Mailing Address - Country:US
Mailing Address - Phone:254-498-1503
Mailing Address - Fax:
Practice Address - Street 1:1601 E RANCIER AVE
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76541-3735
Practice Address - Country:US
Practice Address - Phone:254-498-1503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-19
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care