MEDICARE: FAMILY CHOICE MEDICAL CLINIC PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	ME101902	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ME101902	OTHER	FL	MEDICAL LICENSE NUMBER

General Provider Information

NPI Number	:	1215232426
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY CHOICE MEDICAL CLINIC PA

Provider Business Mailing Address
First Line	:	14834 HORSESHOE TRCE
Second Line	:
City	:	WELLINGTON
State	:	FL
Zip	:	33414-4032
Country	:	US
Telephone Number	:	410-852-5138
Fax Number	:	561-247-7792

Provider Business Practice Location Address
First Line	:	4698 FOREST HILL BLVD
Second Line	:	SUITE B
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33415-5719
Country	:	US
Telephone Number	:	410-852-5138
Fax Number	:	561-247-7792

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHINYERE CHRIS MBAERI
Credential	:	M.D.
Telephone Number	:	410-852-5138

Provider Enumeration Date	:	01/19/2011
Last Update Date	:	02/22/2011

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