Provider Demographics
NPI:1730147463
Name:CHOICE MEDICAL BILLING AND SUPPLY, INC
Entity type:Organization
Organization Name:CHOICE MEDICAL BILLING AND SUPPLY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CLEMENT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-531-6222
Mailing Address - Street 1:111 S DIXIELAND RD
Mailing Address - Street 2:
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-4021
Mailing Address - Country:US
Mailing Address - Phone:479-636-6510
Mailing Address - Fax:479-636-6597
Practice Address - Street 1:111 S DIXIELAND RD
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-4021
Practice Address - Country:US
Practice Address - Phone:479-636-6510
Practice Address - Fax:479-636-6597
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHOICE MEDICAL BILLING AND SUPPLY, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-05-03
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARMG00474332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR47349OtherBLUE CROSS/BLUE SHIELD
MO626095301Medicaid
AR4469430001Medicare NSC
AR4469430003Medicare NSC