Provider Demographics
NPI:1619488418
Name:SUPREME MEDICAL LABORATORIES LLC
Entity Type:Organization
Organization Name:SUPREME MEDICAL LABORATORIES LLC
Other - Org Name:BIOMEDIX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:L
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-207-1696
Mailing Address - Street 1:3803 PARKWOOD BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-8643
Mailing Address - Country:US
Mailing Address - Phone:469-850-0548
Mailing Address - Fax:469-995-8238
Practice Address - Street 1:3803 PARKWOOD BLVD STE 400
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-8643
Practice Address - Country:US
Practice Address - Phone:469-850-0548
Practice Address - Fax:469-850-0547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-19
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory