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General NPI Number Information
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NPI Number | 1447669239
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Entity Type | Organization
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Legal Business Name | SUPERIOR MEDICAL DME & SUPPLIES LLC
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Dates
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Enumeration Date | 08/06/2014
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Last Update Date | 08/06/2014
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Provider Practice Location Address
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Address Line | 4007 ESTATE DIAMOND RUBY
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City | CHRISTIANSTED
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State | VI
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Zip | 00820-4435
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Country | US
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Telephone | 340-727-6300
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Fax | 305-260-6337
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Provider Business Mailing Address
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Address Line | PO BOX 5702
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City | CHRISTIANSTED
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State | VI
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Zip | 00823-5702
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Country | US
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Telephone | 340-513-2061
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Fax | 305-260-6337
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. STEVE A WILSON
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Credential |
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Telephone | 340-513-2061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BD1200X
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Taxonomy Name | Dialysis Equipment & Supplies (DME)
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License Number | 584492
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License Number State | VI
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Taxonomy #2
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Taxonomy Code | 332BP3500X
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Taxonomy Name | Parenteral & Enteral Nutrition Supplies (DME)
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License Number | 584492
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License Number State | VI
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Taxonomy #3
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 584492
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License Number State | VI
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Taxonomy #4
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 584492
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License Number State | VI
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