Provider Demographics
NPI:1134540982
Name:PROFESSIONALS CHOICE MEDICAL SUPPLIES AND SPECIAL TRANSPORT
Entity type:Organization
Organization Name:PROFESSIONALS CHOICE MEDICAL SUPPLIES AND SPECIAL TRANSPORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LATISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHELTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-508-6313
Mailing Address - Street 1:2017 NE FULL MOON DR
Mailing Address - Street 2:K8
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-6340
Mailing Address - Country:US
Mailing Address - Phone:541-508-6313
Mailing Address - Fax:
Practice Address - Street 1:2017 NE FULL MOON DR
Practice Address - Street 2:K8
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-6340
Practice Address - Country:US
Practice Address - Phone:541-508-6313
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-20
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BD1200XSuppliersDurable Medical Equipment & Medical SuppliesDialysis Equipment & Supplies
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)