Provider Demographics
NPI:1861408072
Name:CHOICE MEDICAL BILLING & SUPPLY, INC.
Entity type:Organization
Organization Name:CHOICE MEDICAL BILLING & SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BETTY
Authorized Official - Middle Name:J
Authorized Official - Last Name:CLEMENT
Authorized Official - Suffix:
Authorized Official - Credentials:LRCP
Authorized Official - Phone:479-636-6510
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:479-238-8265
Mailing Address - Fax:
Practice Address - Street 1:1004 S MOUNT OLIVE ST STE L
Practice Address - Street 2:
Practice Address - City:SILOAM SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:72761-4223
Practice Address - Country:US
Practice Address - Phone:479-238-8265
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR244516-78-003332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200051650AMedicaid
AR146800716Medicaid
AR4469430003Medicare NSC