MEDICARE: DOCTORS CHOICE GROUP INC

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	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1881844405
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOCTORS CHOICE GROUP INC

Provider Business Mailing Address
First Line	:	459 MAIN ST
Second Line	:	SUITE 101
City	:	TRUSSVILLE
State	:	AL
Zip	:	35173-1418
Country	:	US
Telephone Number	:	256-393-6054
Fax Number	:

Provider Business Practice Location Address
First Line	:	459 MAIN ST
Second Line	:	SUITE 101
City	:	TRUSSVILLE
State	:	AL
Zip	:	35173-1418
Country	:	US
Telephone Number	:	256-393-6054
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ORLANDO J QUINONEZ
Credential	:
Telephone Number	:	256-393-6054

Provider Enumeration Date	:	09/19/2008
Last Update Date	:	09/19/2008

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