=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477545960
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUPERIOR DME, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/19/2005
-----------------------------------------------------
Last Update Date | 11/22/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1525 COMMON DR., STE B
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79936-5949
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-778-7959
-----------------------------------------------------
Fax | 915-778-0301
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1525 COMMON DR., STE. B
-----------------------------------------------------
City | EL PASO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79936-5949
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 915-778-7959
-----------------------------------------------------
Fax | 915-778-0301
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR/PRESIDENT
-----------------------------------------------------
Name | MRS. ESTHER V. ZAMUDIO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 915-778-7959
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------