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General NPI Number Information
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NPI Number | 1023028420
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Entity Type | Organization
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Legal Business Name | SUPERIOR HOME MEDICAL
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Dates
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Enumeration Date | 08/08/2006
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Last Update Date | 07/18/2007
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Provider Practice Location Address
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Address Line | 1001 N 6TH ST STE B
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City | BLYTHEVILLE
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State | AR
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Zip | 72315-1707
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Country | US
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Telephone | 870-762-5959
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Fax |
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Provider Business Mailing Address
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Address Line | 605 S RIDGEWAY DR
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City | BLYTHEVILLE
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State | AR
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Zip | 72315-8014
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Country | US
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Telephone | 770-763-7993
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SHANDALA NICOLE SMITH
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Credential |
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Telephone | 870-763-7993
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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