CHOICE MEDICAL HEALTHCARE LLC

Provider Demographics

• NPI: 1730163981
• Name: CHOICE MEDICAL HEALTHCARE LLC
• Entity type: Organization
• Organization Name: CHOICE MEDICAL HEALTHCARE LLC
• Authorized Official - Title/Position: CEO
• Authorized Official - First Name: STEPHEN
• Authorized Official - Last Name: GRIGGS
• Authorized Official - Phone: 407-206-0040
• Mailing Address - Street 1: 220 W GERMANTOWN PIKE STE 250
• Mailing Address - City: PLYMOUTH MEETING
• Mailing Address - State: PA
• Mailing Address - Zip Code: 19462-1437
• Mailing Address - Country: US
• Mailing Address - Phone: 410-409-8741
• Practice Address - Street 1: 56 E BROADWAY STE 600
• Practice Address - City: SALT LAKE CITY
• Practice Address - State: UT
• Practice Address - Zip Code: 84111-2211
• Practice Address - Country: US
• Practice Address - Phone: 801-386-5806
• Practice Address - Fax: 801-904-3916
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2005-12-01
• Last Update Date: 2021-04-28

Provider Licenses

State	License ID	Taxonomies
IL	203-000470	332B00000X
		332BC3200X, 332BX2000X
UT	8174000-1714	332B00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies
No	332BC3200X	Suppliers	Durable Medical Equipment & Medical Supplies	Customized Equipment
No	332BX2000X	Suppliers	Durable Medical Equipment & Medical Supplies	Oxygen Equipment & Supplies

Provider Identifiers

State	Identifier ID	ID Type	Issuer
AL	117529	Medicaid
IN	200497500A	Medicaid
MD	026548900	Medicaid
VA	1730163981	Medicaid
MN	7657000	Medicaid
KS	200656190A	Medicaid
AZ	428882	Medicaid
NE	1025841900	Medicaid
MO	1730163981	Medicaid
CT	1730163981/MCS008004	Medicaid
OH	260053974-00	Medicaid
WA	1730163981	Medicaid
OK	2002587470A	Medicaid
WV	3810017856	Medicaid
NY	3144823	Medicaid
MI	4800352	Medicaid
UT	1730163981	Medicaid
WI	1730163981	Medicaid
KY	7100107510	Medicaid
IA	722389	Medicaid
AZ	428882	Medicaid
MN	7657000	Medicaid