MEDICARE: SUPERIOR MED DME, LLC

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	802151257	TX

General Provider Information

NPI Number	:	1982095634
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERIOR MED DME, LLC

Provider Business Mailing Address
First Line	:	320 REGAL ROW
Second Line	:	SUITE 100
City	:	DALLAS
State	:	TX
Zip	:	75247-5200
Country	:	US
Telephone Number	:	972-557-7000
Fax Number	:	972-557-7001

Provider Business Practice Location Address
First Line	:	320 REGAL ROW
Second Line	:	SUITE 100
City	:	DALLAS
State	:	TX
Zip	:	75247-5200
Country	:	US
Telephone Number	:	972-557-7000
Fax Number	:	972-557-7001

Authorized Official
Title or Position	:	MANAGER
Name	:	JOSEPH YSBRAND
Credential	:	D.C.
Telephone Number	:	817-372-1719

Provider Enumeration Date	:	02/16/2015
Last Update Date	:	02/16/2015

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