Provider Demographics
NPI:1013410273
Name:CHOSEN 2 CARE MEDICAL CENTER INC
Entity Type:Organization
Organization Name:CHOSEN 2 CARE MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:MLP-NP
Authorized Official - Phone:205-542-9226
Mailing Address - Street 1:2104 5TH ST N STE 6
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-2236
Mailing Address - Country:US
Mailing Address - Phone:205-542-9226
Mailing Address - Fax:
Practice Address - Street 1:2104 5TH ST N STE 6
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-2236
Practice Address - Country:US
Practice Address - Phone:205-542-9226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-14
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSWARR-P4LBGN363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty