Provider Demographics
NPI:1386643518
Name:CHOICE MEDICAL CARE, PSC
Entity Type:Organization
Organization Name:CHOICE MEDICAL CARE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:JARVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:270-688-0900
Mailing Address - Street 1:815 E PARRISH AVE
Mailing Address - Street 2:SUITE 330
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-3222
Mailing Address - Country:US
Mailing Address - Phone:270-688-0900
Mailing Address - Fax:270-685-0050
Practice Address - Street 1:815 E PARRISH AVE
Practice Address - Street 2:SUITE 330
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3222
Practice Address - Country:US
Practice Address - Phone:270-688-0900
Practice Address - Fax:270-685-0050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY15139207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
104357OtherBLACK LUNG
1524493OtherUMWA
IN200154350AMedicaid
KY65929275Medicaid
000000041803OtherANTHEM BCBS
KY65929275Medicaid
104357OtherBLACK LUNG