Healthcare Provider Details

I. General information

NPI: 1225294184
Provider Name (Legal Business Name): SUPERIOR MEDICAL APPLICATIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 06/08/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14120 HIGHWAY 210 SOUTH
SPRING LAKE NC
28390-9432
US

IV. Provider business mailing address

14120 HIGHWAY 210 SOUTH
SPRING LAKE NC
28390-9432
US

V. Phone/Fax

Practice location:
  • Phone: 910-497-7655
  • Fax: 910-497-7658
Mailing address:
  • Phone: 910-497-7655
  • Fax: 910-497-7658

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. DALE WATSON GRIFFIN
Title or Position: OWNER
Credential:
Phone: 910-497-7655