Provider Demographics
NPI:1588770820
Name:CHOICE MEDICAL SUPPLY INC
Entity type:Organization
Organization Name:CHOICE MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:J'LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:325-677-2250
Mailing Address - Street 1:17 WINDMILL CIR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5234
Mailing Address - Country:US
Mailing Address - Phone:325-677-2250
Mailing Address - Fax:325-677-2124
Practice Address - Street 1:1705 HWY 1431
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654-4921
Practice Address - Country:US
Practice Address - Phone:830-798-9248
Practice Address - Fax:830-798-9249
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHOICE MEDICAL SUPPLY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-21
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14059332B00000X
TX0065657332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX519707OtherBLUE CROSS BLUE SHEILD
TX10013733OtherAMERIGROUP MEDICAID
TX112361OtherSUPERIOR MEDICAID NUMBER
TX157888202Medicaid
TX112361OtherSUPERIOR MEDICAID NUMBER
TX=========002OtherTRICARE