Provider Demographics
NPI:1639434681
Name:PHYSICIAN'S CHOICE MEDICAL SUPPLY
Entity Type:Organization
Organization Name:PHYSICIAN'S CHOICE MEDICAL SUPPLY
Other - Org Name:B.A.T. DISTRIBUTUION, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAMIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-984-1238
Mailing Address - Street 1:6320 VAN NUYS BLVD
Mailing Address - Street 2:SUITE 223
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91401-2617
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6320 VAN NUYS BLVD
Practice Address - Street 2:SUITE 223
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91401-2617
Practice Address - Country:US
Practice Address - Phone:818-984-1238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:B.A.T. DISTRIBUTION, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies