Provider Demographics
NPI:1679051171
Name:SUPAI LLC
Entity type:Organization
Organization Name:SUPAI LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:HITPREET
Authorized Official - Middle Name:
Authorized Official - Last Name:SANGHERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-933-1010
Mailing Address - Street 1:13350 N 94TH DR STE A101
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-4826
Mailing Address - Country:US
Mailing Address - Phone:623-933-1010
Mailing Address - Fax:623-933-3383
Practice Address - Street 1:13350 N 94TH DR STE A101
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85381-4826
Practice Address - Country:US
Practice Address - Phone:623-933-1010
Practice Address - Fax:623-933-3383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-06
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty