Provider Demographics
NPI:1912184466
Name:A HEALTHY CHOICE CLINIC
Entity Type:Organization
Organization Name:A HEALTHY CHOICE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ETHAN
Authorized Official - Last Name:VAN NORDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:620-804-0385
Mailing Address - Street 1:612 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:LARNED
Mailing Address - State:KS
Mailing Address - Zip Code:67550-3049
Mailing Address - Country:US
Mailing Address - Phone:620-285-6041
Mailing Address - Fax:620-285-6149
Practice Address - Street 1:612 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:LARNED
Practice Address - State:KS
Practice Address - Zip Code:67550-3049
Practice Address - Country:US
Practice Address - Phone:620-285-6041
Practice Address - Fax:620-285-6149
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-28
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-30418261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care