Provider Demographics
NPI:1609821362
Name:CHOICE MEDICAL SUPPLIES, INC.
Entity type:Organization
Organization Name:CHOICE MEDICAL SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-286-2000
Mailing Address - Street 1:2035 120TH AVE NE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2141
Mailing Address - Country:US
Mailing Address - Phone:425-646-0907
Mailing Address - Fax:425-646-5473
Practice Address - Street 1:2035 120TH AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2141
Practice Address - Country:US
Practice Address - Phone:425-646-0907
Practice Address - Fax:425-646-5473
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BYRAM HEALTHCARE CENTERS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-23
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID3258700Medicaid
WA9042912Medicaid
WA9036070Medicaid
WA9019688Medicaid
MT0562900Medicaid
CADME03066FMedicaid
WA9036070Medicaid
UT=========005Medicaid