| Supreme Medical Center Llc | |
|
8109 Antoine Dr Houston TX 77088-2801 | |
| (844) 245-8747 | |
| (844) 258-8747 |
| Full Name | Supreme Medical Center Llc |
|---|---|
| Speciality | General Practice |
| Location | 8109 Antoine Dr, Houston, Texas |
| Authorized Official Name and Position | Brittany Green (OWNER) |
| Authorized Official Contact | 2819758182 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Supreme Medical Center Llc 8109 Antoine Dr Houston TX 77088-2801 Ph: (281) 975-8182 | Supreme Medical Center Llc 8109 Antoine Dr Houston TX 77088-2801 Ph: (844) 245-8747 |
| NPI Number | 1023573805 |
|---|---|
| Provider Enumeration Date | 02/05/2019 |
| Last Update Date | 11/04/2024 |
| Medicare PECOS PAC ID | 3577803592 |
|---|---|
| Medicare Enrollment ID | O20190724001273 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023573805 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
| Provider Name | Christle D Colbert |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1649439712 PECOS PAC ID: 2264688050 Enrollment ID: I20120810000026 |
| Provider Name | Kelechi Azuogu |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1003220625 PECOS PAC ID: 4183919137 Enrollment ID: I20161011002665 |
| Provider Name | Kristin N Junek |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669944617 PECOS PAC ID: 8729314760 Enrollment ID: I20190729001144 |
| Provider Name | Kenyatta Robinson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1417452889 PECOS PAC ID: 4587098132 Enrollment ID: I20200107002009 |
| Provider Name | Pamela Gamble |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902454986 PECOS PAC ID: 1456782424 Enrollment ID: I20200506001941 |
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