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General NPI Number Information
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NPI Number | 1760658876
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL HEALTH CHOICE, INC.
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Dates
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Enumeration Date | 05/08/2008
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Last Update Date | 08/24/2012
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Provider Practice Location Address
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Address Line | 4994 N PINE ISLAND ROAD
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City | LAUDERHILL
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State | FL
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Zip | 33351
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Country | US
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Telephone | 954-746-4098
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Fax | 954-746-1194
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Provider Business Mailing Address
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Address Line | 4994 N PINE ISLAND ROAD
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City | LAUDERHILL
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State | FL
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Zip | 33351
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Country | US
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Telephone | 954-746-4098
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Fax | 954-746-1194
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | MR. LUCIOUS COLEMAN
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Credential |
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Telephone | 954-746-2558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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