Provider Demographics
NPI:1801234596
Name:SUPRACARE FAMILY HEALTH PLLC
Entity type:Organization
Organization Name:SUPRACARE FAMILY HEALTH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:PIRKEY
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:903-628-7877
Mailing Address - Street 1:310 E HOSKINS ST
Mailing Address - Street 2:
Mailing Address - City:NEW BOSTON
Mailing Address - State:TX
Mailing Address - Zip Code:75570-2727
Mailing Address - Country:US
Mailing Address - Phone:903-628-7877
Mailing Address - Fax:903-628-7631
Practice Address - Street 1:310 E HOSKINS ST
Practice Address - Street 2:
Practice Address - City:NEW BOSTON
Practice Address - State:TX
Practice Address - Zip Code:75570-2727
Practice Address - Country:US
Practice Address - Phone:903-628-7877
Practice Address - Fax:903-628-7631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-05
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care