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General NPI Number Information
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NPI Number | 1558609974
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Entity Type | Organization
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Legal Business Name | SUPERIOR HEALTH SUPPORT SYSTEM
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Dates
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Enumeration Date | 01/18/2013
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Last Update Date | 01/18/2013
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Provider Practice Location Address
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Address Line | 1501 W 6TH AVE
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City | SAULT SAINTE MARIE
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State | MI
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Zip | 49783-1496
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Country | US
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Telephone | 906-635-6911
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Fax | 906-635-8399
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Provider Business Mailing Address
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Address Line | 1501 W 6TH AVE
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City | SAULT SAINTE MARIE
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State | MI
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Zip | 49783-1496
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Country | US
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Telephone | 906-635-6911
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Fax | 906-635-8399
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | MS. JACLYN MARIE CARNAHAN
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Credential |
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Telephone | 906-635-6911
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | 18002165740
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License Number State | MI
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