Provider Demographics
NPI:1710557699
Name:AMERICA CHOICE FAMILY CLINIC AND BEHAVIOR HEALTH
Entity Type:Organization
Organization Name:AMERICA CHOICE FAMILY CLINIC AND BEHAVIOR HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:MENARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-245-1698
Mailing Address - Street 1:11352 SW WYNDHAM WAY
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34987-2784
Mailing Address - Country:US
Mailing Address - Phone:239-245-1698
Mailing Address - Fax:
Practice Address - Street 1:15701 STATE ROAD 50 STE 204
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-9203
Practice Address - Country:US
Practice Address - Phone:239-245-1698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-01
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110406100Medicaid