Provider Demographics
NPI:1477999381
Name:PREMIER CHOICE MEDICAL, LLC
Entity Type:Organization
Organization Name:PREMIER CHOICE MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHYKEETRA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MALTBIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:251-447-2953
Mailing Address - Street 1:6420 HILLCREST PARK CT
Mailing Address - Street 2:SUITE B
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-2688
Mailing Address - Country:US
Mailing Address - Phone:251-447-2953
Mailing Address - Fax:251-447-2745
Practice Address - Street 1:6420 HILLCREST PARK CT
Practice Address - Street 2:SUITE B
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36695-2688
Practice Address - Country:US
Practice Address - Phone:251-447-2953
Practice Address - Fax:251-447-2745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-18
Last Update Date:2013-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL29376208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty