Healthcare Provider Details

I. General information

NPI: 1447669239
Provider Name (Legal Business Name): SUPERIOR MEDICAL DME & SUPPLIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2014
Last Update Date: 08/06/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4007 ESTATE DIAMOND RUBY
CHRISTIANSTED VI
00820-4435
US

IV. Provider business mailing address

PO BOX 5702
CHRISTIANSTED VI
00823-5702
US

V. Phone/Fax

Practice location:
  • Phone: 340-727-6300
  • Fax: 305-260-6337
Mailing address:
  • Phone: 340-513-2061
  • Fax: 305-260-6337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number584492
License Number StateVI
# 2
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number584492
License Number StateVI
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number584492
License Number StateVI
# 4
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number584492
License Number StateVI

VIII. Authorized Official

Name: MR. STEVE A WILSON
Title or Position: PRESIDENT
Credential:
Phone: 340-513-2061