Provider Demographics
NPI:1629879846
Name:SUPREME BUY LLC
Entity type:Organization
Organization Name:SUPREME BUY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BILAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KHALID
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:209-788-9435
Mailing Address - Street 1:4307 WAXWING ST
Mailing Address - Street 2:
Mailing Address - City:HOSCHTON
Mailing Address - State:GA
Mailing Address - Zip Code:30548-5538
Mailing Address - Country:US
Mailing Address - Phone:209-788-9435
Mailing Address - Fax:
Practice Address - Street 1:4307 WAXWING ST
Practice Address - Street 2:
Practice Address - City:HOSCHTON
Practice Address - State:GA
Practice Address - Zip Code:30548-5538
Practice Address - Country:US
Practice Address - Phone:209-788-9435
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-24
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies