Provider Demographics
NPI:1760574677
Name:PROFESSIONAL CHOICE
Entity Type:Organization
Organization Name:PROFESSIONAL CHOICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:E
Authorized Official - Last Name:MENDENHALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-735-1030
Mailing Address - Street 1:3802 AUBURN WAY N
Mailing Address - Street 2:SUITE 301
Mailing Address - City:AUBURN
Mailing Address - State:WA
Mailing Address - Zip Code:98002-1400
Mailing Address - Country:US
Mailing Address - Phone:253-735-0130
Mailing Address - Fax:253-735-6072
Practice Address - Street 1:3802 AUBURN WAY N
Practice Address - Street 2:SUITE 301
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-1400
Practice Address - Country:US
Practice Address - Phone:253-735-0130
Practice Address - Fax:253-735-6072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9044660Medicaid
WA1274140001Medicare ID - Type Unspecified