Superior Physician Group

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

SUPERIOR PHYSICIAN GROUP

Practice address

10730 N 56TH St Ste 209
Temple Terrace, FL 33617

Phone

(813) 365-5680

NPI assigned

May 18, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Renii Modisette

Title

Operations Manager

Phone

(813) 365-5680

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1526601600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526947200000",
    "number": "1164912754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10730 N 56TH ST STE 209",
            "city": "TEMPLE TERRACE",
            "state": "FL",
            "postal_code": "336173611",
            "telephone_number": "813-365-5680"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10730 N 56TH ST STE 209",
            "city": "TEMPLE TERRACE",
            "state": "FL",
            "postal_code": "33617",
            "telephone_number": "813-365-5680"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERIOR PHYSICIAN GROUP",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-05-18",
        "last_updated": "2018-05-22",
        "status": "A",
        "authorized_official_last_name": "MODISETTE",
        "authorized_official_first_name": "RENII",
        "authorized_official_title_or_position": "OPERATIONS MANAGER",
        "authorized_official_telephone_number": "813-365-5680",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Superior Medical Clinics LLC
• Superior Pharmacy of Temple Terrace
• Superior Pharmacy of Temple Terrace LLC
• Superior Pharmacy of Temple Terrace LLC
• Superior Pharmacy of Temple Terrace, LLC
• Surgcenter Northeast LLC
• Leslie Sutherland, PT
• Suz M.D. LLC
• Sarah Syed, M.D.
• Synergy Home Health and Recovery LLC

• Internal Medicine Physician in Temple Terrace, FL
• Providers in Temple Terrace, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.