MEDICARE: SUPERIOR MEDICAL SUPPLY, 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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1700662657
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERIOR MEDICAL SUPPLY, INC

Provider Business Mailing Address
First Line	:	7414 FOOTHILL BLVD
Second Line	:
City	:	TUJUNGA
State	:	CA
Zip	:	91042-2722
Country	:	US
Telephone Number	:	747-293-0050
Fax Number	:	747-293-0040

Provider Business Practice Location Address
First Line	:	7414 FOOTHILL BLVD
Second Line	:
City	:	TUJUNGA
State	:	CA
Zip	:	91042-2722
Country	:	US
Telephone Number	:	747-293-0050
Fax Number	:	747-293-0040

Authorized Official
Title or Position	:	CEO
Name	:	HAKINT BAGHDASARYAN
Credential	:
Telephone Number	:	747-293-0050

Provider Enumeration Date	:	09/06/2023
Last Update Date	:	09/06/2023

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