NPIMap

Organization Active NPI

Supreme Surgical Associates Inc

  • Specialist
  • Baltimore, MD
National Provider Identifier
1316226020
Registry record updated Aug 11, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
SUPREME SURGICAL ASSOCIATES INC
Practice address
4713 Leeds Ave
Baltimore, MD 21227-1402
Phone
(410) 247-4740
Fax
(410) 247-2346
NPI assigned
Aug 11, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 11, 2011

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

Authorized official

Name
Dr. Efem E Imoke, M.D.
Title
Owner
Phone
(410) 247-4740

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X Primary

Addresses

Primary practice location

4713 Leeds Ave
Baltimore, MD 21227-1402

Mailing address

4713 Leeds Ave
Baltimore, MD 21227-1402
Phone (410) 247-4740

National Provider Directory

National Provider Directory

Locations

4713 Leeds Ave
Baltimore, MD 21227
Phone (410) 247-4740

NPI Registry JSON

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

{
    "created_epoch": "1313020800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1313020800000",
    "number": "1316226020",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4713 LEEDS AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212271402",
            "telephone_number": "410-247-4740",
            "fax_number": "410-247-2346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4713 LEEDS AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212271402",
            "telephone_number": "410-247-4740",
            "fax_number": "410-247-2346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPREME SURGICAL ASSOCIATES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-11",
        "last_updated": "2011-08-11",
        "status": "A",
        "authorized_official_last_name": "IMOKE",
        "authorized_official_first_name": "EFEM",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "410-247-4740",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 11, 2011; 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.