Provider Demographics
NPI:1639231814
Name:CHOICE MEDICAL, LLC
Entity Type:Organization
Organization Name:CHOICE MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HENNING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-232-6000
Mailing Address - Street 1:2117 PHILADELPHIA ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:AMES
Mailing Address - State:IA
Mailing Address - Zip Code:50010-8775
Mailing Address - Country:US
Mailing Address - Phone:515-232-6000
Mailing Address - Fax:515-232-2600
Practice Address - Street 1:2117 PHILADELPHIA ST
Practice Address - Street 2:SUITE 120
Practice Address - City:AMES
Practice Address - State:IA
Practice Address - Zip Code:50010-8775
Practice Address - Country:US
Practice Address - Phone:515-232-6000
Practice Address - Fax:515-232-2600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0262709Medicaid
IA46080OtherWELLMARK
IA4480500001Medicare ID - Type Unspecified