# CHOICE ONE MEDICAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1508172206
- **Authorized official:** MARY C MARTINEZ (VP OPERATIONS & NETWORK MNGT)
- **Authorized official phone:** (954) 703-6065

## Contact information

- **Practice address:** 511 NE 3RD AVE, FORT LAUDERDALE, FL 33301-3235
- **Practice address phone:** (954) 903-0468
- **Practice address fax:** (561) 828-3372
- **Mailing address:** 49 N FEDERAL HWY, STE 350, POMPANO BEACH, FL 33062-4304
- **Mailing address phone:** (954) 703-6065
- **Mailing address fax:** (561) 828-3372

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 171W00000X | Contractor | — | NULL | Yes |
| 171W00000X | Contractor | — | — | Yes |
| 261QH0100X | Health Service Clinic/Center | — | NULL | — |
| 302F00000X | Exclusive Provider Organization | — | FL | — |

## Other

- **Enumeration date:** 08/19/2010
- **Last updated:** 02/25/2015