Provider Demographics
NPI:1043921430
Name:CHOICEHEALTH MEMBER MEDICAL LLC
Entity Type:Organization
Organization Name:CHOICEHEALTH MEMBER MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YODAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-383-4560
Mailing Address - Street 1:PO BOX 229
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:VA
Mailing Address - Zip Code:24482-0229
Mailing Address - Country:US
Mailing Address - Phone:540-383-4560
Mailing Address - Fax:
Practice Address - Street 1:2225 N AUGUSTA ST STE B
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-2520
Practice Address - Country:US
Practice Address - Phone:540-383-4560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-07
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty