1831192152 NPI number — SUPERIOR MEDICAL SUPPLY, INC

Table of content: (NPI 1831192152)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831192152 NPI number — SUPERIOR MEDICAL SUPPLY, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUPERIOR MEDICAL SUPPLY, 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:
NEB DOCTORS OF TN
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:
1831192152
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 922189
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORCROSS
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30010-2189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
885-889-6308
Provider Business Mailing Address Fax Number:
888-835-3354

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6025 LEE HWY STE 431
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37421
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-551-9333
Provider Business Practice Location Address Fax Number:
931-551-8435
Provider Enumeration Date:
05/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KAY
Authorized Official First Name:
SUE
Authorized Official Middle Name:
ELLEN
Authorized Official Title or Position:
SR VICE PRESIDENT
Authorized Official Telephone Number:
888-588-9630

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0000000615 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1987144 . This is a "COVENTRY HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: S073099 . This is a "IHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1045278 . This is a "STERLING LIFE INSURANCE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 50002684 . This is a "PASSPORT HEALTH" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 01071796 . This is a "AMERIGROUP COMMUNITY CARE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3123555 . This is a "BLUECROSS BLUESHIELD TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 2444181000 . This is a "PASSPORT ADVANTAGE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 3044 . This is a "CARECENTRIX" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 90274275 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 128747 . This is a "FIRST HEALTH" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 1452422 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 123150 . This is a "UNISON ADVANTAGE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 233009 . This is a "ANTHEM" identifier . This identifiers is of the category "OTHER".




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