1497009112 NPI number — SUPERIOR MEDICAL EQUIPMENT GROUP, INC.

Table of content: (NPI 1497009112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497009112 NPI number — SUPERIOR MEDICAL EQUIPMENT GROUP, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUPERIOR MEDICAL EQUIPMENT GROUP, 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:
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:
1497009112
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1747
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLICOTT CITY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21041-1747
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-461-4675
Provider Business Mailing Address Fax Number:
410-461-5424

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
59 N. 7TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHAMBERSBURG
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
17201-2746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
717-709-4731
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2012

Additional Information

Authorized Official

Authorized Official Last Name:
ROUEN
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
LAWRENCE
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
410-461-4675

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 335E00000X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 193728600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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