Healthcare Provider Details

I. General information

NPI: 1902419187
Provider Name (Legal Business Name): SUPERIOR CHOICE PHYSICIANS INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 04/19/2022
Certification Date: 04/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2519 N MCMULLEN BOOTH RD STE 510-203
CLEARWATER FL
33761-4173
US

IV. Provider business mailing address

2519 N MCMULLEN BOOTH RD STE 510-203
CLEARWATER FL
33761-4173
US

V. Phone/Fax

Practice location:
  • Phone: 407-923-4205
  • Fax:
Mailing address:
  • Phone: 407-923-4205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code2251G0304X
TaxonomyGeriatric Physical Therapist
License Number
License Number State

VIII. Authorized Official

Name: DAVID DEJESUS
Title or Position: CEO
Credential:
Phone: 817-751-1811