Provider Demographics
NPI:1902080997
Name:PROVIDER CHOICE HOME MEDICAL EQUIPMENT, LLC
Entity Type:Organization
Organization Name:PROVIDER CHOICE HOME MEDICAL EQUIPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:W
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MEDICAL SALES MGT
Authorized Official - Phone:972-818-2800
Mailing Address - Street 1:4575 WESTGROVE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-5349
Mailing Address - Country:US
Mailing Address - Phone:928-818-2800
Mailing Address - Fax:972-818-2864
Practice Address - Street 1:4575 WESTGROVE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001-5349
Practice Address - Country:US
Practice Address - Phone:928-818-2800
Practice Address - Fax:972-818-2864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2009-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6196660001Medicare NSC