Provider Demographics
NPI:1821758442
Name:PREMIER CHOICE PRIMARY & URGENT CARE, LLC
Entity Type:Organization
Organization Name:PREMIER CHOICE PRIMARY & URGENT CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:CLARA & TAIEB
Authorized Official - Middle Name:
Authorized Official - Last Name:BACCOUCHE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:240-432-8025
Mailing Address - Street 1:12301 OLD COLUMBIA PIKE STE 100A
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1659
Mailing Address - Country:US
Mailing Address - Phone:240-855-4923
Mailing Address - Fax:
Practice Address - Street 1:12301 OLD COLUMBIA PIKE STE 100A
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1659
Practice Address - Country:US
Practice Address - Phone:240-855-4923
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-22
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies