MEDICARE: SUPERIOR SURGICAL SERVICES, LLC

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	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1417503467
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERIOR SURGICAL SERVICES, LLC

Provider Business Mailing Address
First Line	:	P.O. BOX 19368
Second Line	:
City	:	SUGAR LAND
State	:	TX
Zip	:	77496
Country	:	US
Telephone Number	:	832-656-0597
Fax Number	:

Provider Business Practice Location Address
First Line	:	5527 YORKWOOD ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77016
Country	:	US
Telephone Number	:	832-656-0597
Fax Number	:

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	MRS. SYLVIA AMY PENNIE
Credential	:	LSA
Telephone Number	:	832-656-0597

Provider Enumeration Date	:	08/15/2019
Last Update Date	:	08/15/2019

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