MEDICARE: SUPERIOR AIR-GROUND AMBULANCE SERVICE OF OHIO INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance

General Provider Information

NPI Number	:	1023632890
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERIOR AIR-GROUND AMBULANCE SERVICE OF OHIO INC

Provider Business Mailing Address
First Line	:	395 W LAKE ST
Second Line	:
City	:	ELMHURST
State	:	IL
Zip	:	60126-1508
Country	:	US
Telephone Number	:	630-832-2012
Fax Number	:

Provider Business Practice Location Address
First Line	:	2160 SOUTHWEST BLVD
Second Line	:
City	:	GROVE CITY
State	:	OH
Zip	:	43123-1893
Country	:	US
Telephone Number	:	614-871-3210
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DAVID B HILL III
Credential	:
Telephone Number	:	630-832-2012

Provider Enumeration Date	:	06/08/2020
Last Update Date	:	09/23/2020

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