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Organization
CHOICE ONE MEDICAL GROUP LLC
Active
Organization
CHOICE ONE MEDICAL GROUP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY C MARTINEZ (VP OPERATIONS & NETWORK MNGT)
(954) 703-6065
Entity
Organization
Contact information
Practice address
511 NE 3RD AVE, FORT LAUDERDALE, FL 33301-3235
(954) 903-0468
(561) 828-3372
Mailing address
49 N FEDERAL HWY, STE 350, POMPANO BEACH, FL 33062-4304
(954) 703-6065
(561) 828-3372
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
261QH0100X
Health Service Clinic/Center
—
—
302F00000X
Exclusive Provider Organization
—
FL
Other
Enumeration date
08/19/2010
Last updated
02/25/2015
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