Provider Demographics
NPI:1215201157
Name:CHOICE WELLNESS, LLC
Entity Type:Organization
Organization Name:CHOICE WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:J
Authorized Official - Last Name:AGIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-230-1438
Mailing Address - Street 1:26212 US HIGHWAY 19 N
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33761-3580
Mailing Address - Country:US
Mailing Address - Phone:727-230-1438
Mailing Address - Fax:727-230-1437
Practice Address - Street 1:26212 US HIGHWAY 19 N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33761-3580
Practice Address - Country:US
Practice Address - Phone:727-230-1438
Practice Address - Fax:727-230-1437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-23
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME83513174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty