Provider Demographics
NPI:1114973609
Name:PREMIUM CHOICE MEDICAL INC
Entity Type:Organization
Organization Name:PREMIUM CHOICE MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LEIDY
Authorized Official - Middle Name:I
Authorized Official - Last Name:BOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-866-0216
Mailing Address - Street 1:311 DEL PRADO BLVD
Mailing Address - Street 2:UNIT 1
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990
Mailing Address - Country:US
Mailing Address - Phone:239-574-9121
Mailing Address - Fax:239-574-9028
Practice Address - Street 1:311 DEL PRADO BLVD
Practice Address - Street 2:UNIT 1
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990
Practice Address - Country:US
Practice Address - Phone:239-574-9121
Practice Address - Fax:239-574-9028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5712380001Medicare ID - Type UnspecifiedMEDICARE