=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558546697
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUPERIOR MONITORING ASSOCIATES LP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2008
-----------------------------------------------------
Last Update Date | 01/08/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4004 BELTLINE ROAD SUITE 207 LOCKBOX 4
-----------------------------------------------------
City | ADDISON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75001-4370
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-663-9514
-----------------------------------------------------
Fax | 817-379-0892
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4004 BELTLINE ROAD SUITE 207 LOCKBOX 4
-----------------------------------------------------
City | ADDISON
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-663-9514
-----------------------------------------------------
Fax | 817-379-0892
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MR. RON C HATFIELD
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 877-663-9514
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 293D00000X
-----------------------------------------------------
Taxonomy Name | Physiological Laboratory
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------