Provider Demographics
NPI:1023249034
Name:SUPERIOR CHOICE
Entity type:Organization
Organization Name:SUPERIOR CHOICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBOSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-974-1147
Mailing Address - Street 1:PO BOX 3218
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77347-3218
Mailing Address - Country:US
Mailing Address - Phone:281-974-1147
Mailing Address - Fax:
Practice Address - Street 1:8213 HOMESTEAD RD
Practice Address - Street 2:SUITE A
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77028-2152
Practice Address - Country:US
Practice Address - Phone:281-974-1147
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service