Healthcare Provider Details

I. General information

NPI: 1497009112
Provider Name (Legal Business Name): SUPERIOR MEDICAL EQUIPMENT GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2012
Last Update Date: 05/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

59 N. 7TH STREET
CHAMBERSBURG PA
17201-2746
US

IV. Provider business mailing address

PO BOX 1747
ELLICOTT CITY MD
21041-1747
US

V. Phone/Fax

Practice location:
  • Phone: 717-709-4731
  • Fax:
Mailing address:
  • Phone: 410-461-4675
  • Fax: 410-461-5424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number StateMD

VIII. Authorized Official

Name: MR. DAVID LAWRENCE ROUEN
Title or Position: PRESIDENT/OWNER
Credential:
Phone: 410-461-4675