Provider Demographics
NPI:1316226020
Name:SUPREME SURGICAL ASSOCIATES INC
Entity Type:Organization
Organization Name:SUPREME SURGICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EFEM
Authorized Official - Middle Name:E
Authorized Official - Last Name:IMOKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-247-4740
Mailing Address - Street 1:4713 LEEDS AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21227-1402
Mailing Address - Country:US
Mailing Address - Phone:410-247-4740
Mailing Address - Fax:410-247-2346
Practice Address - Street 1:4713 LEEDS AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21227-1402
Practice Address - Country:US
Practice Address - Phone:410-247-4740
Practice Address - Fax:410-247-2346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty