United Supermarkets, L.L.C.

Primary specialty

PharmacyTaxonomy code 333600000X

License

22751 Issued in TX

Legal business name

UNITED SUPERMARKETS, L.L.C.

Practice address

5605 Colleyville Blvd
Colleyville, TX 76034-6022

Phone

(817) 577-5030

Fax

(817) 577-5035

NPI assigned

Dec 30, 2005

Organization subpart

No

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

Authorized official

Name

Tim Purser, RPH

Title

Third Party Administrator

Phone

(806) 791-0220

Specialties & licenses 2

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Enrolled in TX

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• United Supermarkets LLC

  • Community/Retail Pharmacy
  • Colleyville, TX
  • NPI 1073651162

  O20100930030330

  Same enrollment

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

{
    "created_epoch": "1135900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1192579200000",
    "number": "1649257551",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7830 ORLANDO AVE",
            "city": "LUBBOCK",
            "state": "TX",
            "postal_code": "794231942",
            "telephone_number": "806-791-0220",
            "fax_number": "806-791-7490"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5605 COLLEYVILLE BLVD",
            "city": "COLLEYVILLE",
            "state": "TX",
            "postal_code": "760346022",
            "telephone_number": "817-577-5030",
            "fax_number": "817-577-5035"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNITED SUPERMARKETS, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-30",
        "last_updated": "2007-10-17",
        "status": "A",
        "authorized_official_last_name": "PURSER",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "THIRD PARTY ADMINISTRATOR",
        "authorized_official_telephone_number": "806-791-0220",
        "authorized_official_credential": "RPH"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TX",
            "license": "22751",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "TX",
            "license": "22751",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "465443",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER#",
            "identifier": "PH0436",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "4529799",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• TX Southern Dental PPO PC
• Christopher L Tye, MD DDS
• Pei-Yih Bryan Tzeng, MA, LPC
• Mohammad N Uddin, MD
• United Supermarkets LLC
• Babita Upreti
• Jonathan Michael Urrutia, DC
• Susan Diane Urry, CCC-SLP
• Binny Valera
• Van Beljon LLC

• Pharmacy in Colleyville, TX
• Providers in Colleyville, TX by specialty
• Pharmacy in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.