MEDICARE: SUPERIOR CHOICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	305S00000X	Point of Service

General Provider Information

NPI Number	:	1023249034
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERIOR CHOICE

Provider Business Mailing Address
First Line	:	PO BOX 3218
Second Line	:
City	:	HUMBLE
State	:	TX
Zip	:	77347-3218
Country	:	US
Telephone Number	:	281-974-1147
Fax Number	:

Provider Business Practice Location Address
First Line	:	8213 HOMESTEAD RD
Second Line	:	SUITE A
City	:	HOUSTON
State	:	TX
Zip	:	77028-2152
Country	:	US
Telephone Number	:	281-974-1147
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TRINA DEBOSE
Credential	:
Telephone Number	:	281-974-1147

Provider Enumeration Date	:	08/07/2009
Last Update Date	:	08/07/2009

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Directions to “SUPERIOR CHOICE ” Practice Location

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