Provider Demographics
NPI:1184645244
Name:CHOICE MEDICAL BILLING AND SUPPLY INC.
Entity Type:Organization
Organization Name:CHOICE MEDICAL BILLING AND SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-636-6510
Mailing Address - Street 1:816 N MAIN ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-2915
Mailing Address - Country:US
Mailing Address - Phone:870-743-2231
Mailing Address - Fax:870-743-2241
Practice Address - Street 1:816 N MAIN ST
Practice Address - Street 2:SUITE 115
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2915
Practice Address - Country:US
Practice Address - Phone:870-743-2231
Practice Address - Fax:870-743-2241
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHOICE MEDICAL BILLING AND SUPPLY INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-22
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMG00749332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR4469430004Medicare ID - Type UnspecifiedPROVIDER NUMBER