Provider Demographics
NPI:1932324621
Name:PHYSICIAN'S CHOICE MEDICAL, LLC
Entity Type:Organization
Organization Name:PHYSICIAN'S CHOICE MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LONNIE
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:DORCEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:205-566-1674
Mailing Address - Street 1:PO BOX 550309
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35255-0309
Mailing Address - Country:US
Mailing Address - Phone:205-566-1674
Mailing Address - Fax:
Practice Address - Street 1:565 E 70TH AVE UNIT 2W
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80229-6713
Practice Address - Country:US
Practice Address - Phone:303-429-7300
Practice Address - Fax:303-487-5365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08003139Medicaid
1113740001Medicare ID - Type Unspecified