Provider Demographics
NPI:1114925856
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 1:17 WINDMILL CIR
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79606-5234
Practice Address - Country:US
Practice Address - Phone:325-677-2250
Practice Address - Fax:325-677-2124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0012861332B00000X
TX0036515332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX519707OtherBCBS PROVIDER NUMBER
TN=========OtherPRIMARY TRICARE PROVIDER#
TX1118690001Medicare NSC