| Supreme Healthcare Pllc | |
|
4619 S Harvard Ave Ste 100 Tulsa OK 74135-2921 | |
| (918) 619-9441 | |
| (918) 619-9442 |
| Full Name | Supreme Healthcare Pllc |
|---|---|
| Speciality | Family Medicine |
| Location | 4619 S Harvard Ave Ste 100, Tulsa, Oklahoma |
| Authorized Official Name and Position | Kandy Kay Keeney (MANAGER) |
| Authorized Official Contact | 9188455498 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Supreme Healthcare Pllc 9521 Riverside Pkwy Ste B Tulsa OK 74137-7422 Ph: (918) 845-5498 | Supreme Healthcare Pllc 4619 S Harvard Ave Ste 100 Tulsa OK 74135-2921 Ph: (918) 619-9441 |
| NPI Number | 1326631862 |
|---|---|
| Provider Enumeration Date | 02/16/2021 |
| Last Update Date | 12/15/2021 |
| Medicare PECOS PAC ID | 6406263052 |
|---|---|
| Medicare Enrollment ID | O20210325002216 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326631862 | NPI | - | NPPES |
| 200993730 | Medicaid | OK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Chad Keeney |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134149180 PECOS PAC ID: 0042225500 Enrollment ID: I20061009000220 |
| Provider Name | Lori L Franklin |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225506918 PECOS PAC ID: 4880939925 Enrollment ID: I20181218003576 |
| Provider Name | Serena Dawne Munoz |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801480017 PECOS PAC ID: 8224406756 Enrollment ID: I20221115000820 |
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