NPIMap

Organization Active NPI

United Supermarkets, L.L.C.

  • Pharmacy
  • Wichita Falls, TX
National Provider Identifier
1710978101
Registry record updated Dec 28, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
21391 Issued in TX
Legal business name
UNITED SUPERMARKETS, L.L.C.
Practice address
4590 Kell Blvd
Wichita Falls, TX 76309-4744
Phone
(940) 692-3443
Fax
(940) 696-5178
NPI assigned
Nov 3, 2005
Last updated
Dec 28, 2007By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2007

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

Authorized official

Name
Tim Purser, RPH
Title
Director Pharmacy Services
Phone
(806) 791-0220

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 21391 TX
Pharmacy 333600000X 21391 TX Primary

Addresses

Primary practice location

4590 Kell Blvd
Wichita Falls, TX 76309-4744

Mailing address

7830 Orlando Ave
Lubbock, TX 79423-1942
Phone (806) 791-0220

Other identifiers 2

IdentifierTypeStateIssuer
4576356OtherTXNCPDP
465180MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930066313 TX DME Supplier - PharmacyDME Supplier - Grocery Store 0143126524 1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Wichita Falls, TX

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1130976000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198800000000",
    "number": "1710978101",
    "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": "4590 KELL BLVD",
            "city": "WICHITA FALLS",
            "state": "TX",
            "postal_code": "763094744",
            "telephone_number": "940-692-3443",
            "fax_number": "940-696-5178"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "UNITED SUPERMARKETS, L.L.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-03",
        "last_updated": "2007-12-28",
        "status": "A",
        "authorized_official_last_name": "PURSER",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "DIRECTOR PHARMACY SERVICES",
        "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": "21391",
            "primary": false
        },
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "TX",
            "license": "21391",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NCPDP",
            "identifier": "4576356",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "465180",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wichita Falls, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 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.