Provider Demographics
NPI:1710199039
Name:FITST CHOIE PRIMARY CARE,LLC
Entity Type:Organization
Organization Name:FITST CHOIE PRIMARY CARE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WLILLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-745-1228
Mailing Address - Street 1:2431 ALOMA AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-2522
Mailing Address - Country:US
Mailing Address - Phone:407-737-8780
Mailing Address - Fax:407-737-8517
Practice Address - Street 1:1154 LEE BLVD
Practice Address - Street 2:SUITE 4
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-4852
Practice Address - Country:US
Practice Address - Phone:239-369-6211
Practice Address - Fax:239-369-1209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty