1063657286 NPI number — UP SUPERIOR ENTERPRISES, INC

Table of content: (NPI 1063657286)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063657286 NPI number — UP SUPERIOR ENTERPRISES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UP SUPERIOR ENTERPRISES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PRESCRIPTION OXYGEN SERVICE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063657286
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2650 I-75 BUSINESS SPUR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAULT STE. MARIE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49783
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
906-632-3772
Provider Business Mailing Address Fax Number:
906-632-0309

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13534 STATE HIGHWAY 28
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEWBERRY
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49868
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
906-293-3556
Provider Business Practice Location Address Fax Number:
906-293-8945
Provider Enumeration Date:
12/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GORDON
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
906-632-2772

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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