Provider Demographics
NPI:1972760544
Name:GREATER PHYSICIAN CHOICE LLC
Entity Type:Organization
Organization Name:GREATER PHYSICIAN CHOICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:MORELAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-547-0428
Mailing Address - Street 1:1880 NACOGDOCHES RD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209-2216
Mailing Address - Country:US
Mailing Address - Phone:210-547-0428
Mailing Address - Fax:866-633-7144
Practice Address - Street 1:1880 NACOGDOCHES RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-2216
Practice Address - Country:US
Practice Address - Phone:210-547-0428
Practice Address - Fax:866-633-7144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-20
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX212759902Medicaid