Provider Demographics
NPI:1215232426
Name:FAMILY CHOICE MEDICAL CLINIC PA
Entity Type:Organization
Organization Name:FAMILY CHOICE MEDICAL CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHINYERE
Authorized Official - Middle Name:CHRIS
Authorized Official - Last Name:MBAERI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-852-5138
Mailing Address - Street 1:14834 HORSESHOE TRCE
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4032
Mailing Address - Country:US
Mailing Address - Phone:410-852-5138
Mailing Address - Fax:561-247-7792
Practice Address - Street 1:4698 FOREST HILL BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33415-5719
Practice Address - Country:US
Practice Address - Phone:410-852-5138
Practice Address - Fax:561-247-7792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-19
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME101902261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME101902OtherMEDICAL LICENSE NUMBER