Provider Demographics
NPI:1225303340
Name:PATIENTS' CHOICE MEDICAL CLINIC LLC
Entity Type:Organization
Organization Name:PATIENTS' CHOICE MEDICAL CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP-C
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOYD
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:601-410-7948
Mailing Address - Street 1:501 AZALEA DR
Mailing Address - Street 2:SUITE F
Mailing Address - City:WAYNESBORO
Mailing Address - State:MS
Mailing Address - Zip Code:39367-2661
Mailing Address - Country:US
Mailing Address - Phone:601-735-3737
Mailing Address - Fax:
Practice Address - Street 1:501 AZALEA DR
Practice Address - Street 2:SUITE F
Practice Address - City:WAYNESBORO
Practice Address - State:MS
Practice Address - Zip Code:39367-2661
Practice Address - Country:US
Practice Address - Phone:601-735-3737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-22
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR867779261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center