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General NPI Number Information
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NPI Number | 1619488418
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Entity Type | Organization
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Legal Business Name | SUPREME MEDICAL LABORATORIES LLC
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Dates
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Enumeration Date | 10/19/2017
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 3803 PARKWOOD BLVD STE 400
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City | FRISCO
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State | TX
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Zip | 75034-8643
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Country | US
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Telephone | 469-850-0548
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Fax | 469-850-0547
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Provider Business Mailing Address
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Address Line | 3803 PARKWOOD BLVD STE 400
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City | FRISCO
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State | TX
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Zip | 75034-8643
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Country | US
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Telephone | 469-850-0548
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Fax | 469-995-8238
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Authorized Official
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Title or Position | CEO
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Name | ROSS L. HARRIS
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Credential |
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Telephone | 214-207-1696
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number |
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License Number State |
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