Provider Demographics
NPI:1922485259
Name:HEALTHY CHOICE
Entity Type:Organization
Organization Name:HEALTHY CHOICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LONDA
Authorized Official - Middle Name:Y
Authorized Official - Last Name:SWOBODA
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:573-564-3214
Mailing Address - Street 1:111 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY CITY
Mailing Address - State:MO
Mailing Address - Zip Code:63361-2550
Mailing Address - Country:US
Mailing Address - Phone:573-564-3214
Mailing Address - Fax:573-564-3216
Practice Address - Street 1:111 E 1ST ST
Practice Address - Street 2:
Practice Address - City:MONTGOMERY CITY
Practice Address - State:MO
Practice Address - Zip Code:63361-2550
Practice Address - Country:US
Practice Address - Phone:573-564-3214
Practice Address - Fax:573-564-3216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-06
Last Update Date:2019-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QR1300X
MO102389363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty