1164949459 NPI number — SUPERIOR EMERGENCY SERVICES CORP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164949459 NPI number — SUPERIOR EMERGENCY SERVICES CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUPERIOR EMERGENCY SERVICES CORP
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:
Provider Other Organization Name Type Code:
6
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:
1164949459
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 190
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN SEBASTIAN
Provider Business Mailing Address State Name:
PR
Provider Business Mailing Address Postal Code:
00685-0190
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
787-560-4206
Provider Business Mailing Address Fax Number:
787-926-0604

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 CALLE RUIZ BELVIS ESQUINA HOSTOS
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN SEBASTIAN
Provider Business Practice Location Address State Name:
PR
Provider Business Practice Location Address Postal Code:
00685
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
787-560-4206
Provider Business Practice Location Address Fax Number:
787-926-0604
Provider Enumeration Date:
08/28/2017

Additional Information

Authorized Official

Authorized Official Last Name:
ORTIZ GONZALEZ
Authorized Official First Name:
KRISTOPHER
Authorized Official Middle Name:
O
Authorized Official Title or Position:
PRESIDENTE
Authorized Official Telephone Number:
787-560-4206

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  TCAMB742 , registered in the state of PR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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