Provider Demographics
NPI:1871966135
Name:LIFE CHOICES MEDICAL CLINIC
Entity type:Organization
Organization Name:LIFE CHOICES MEDICAL CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHARITY
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-543-7200
Mailing Address - Street 1:3234 NORTHWESTERN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-4043
Mailing Address - Country:US
Mailing Address - Phone:210-543-7200
Mailing Address - Fax:210-647-9825
Practice Address - Street 1:3234 NORTHWESTERN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-4043
Practice Address - Country:US
Practice Address - Phone:210-543-7200
Practice Address - Fax:210-647-9825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health