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General NPI Number Information
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NPI Number | 1720046188
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Entity Type | Organization
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Legal Business Name | SUPERIOR AIR-GROUND AMBULANCE SERVICE OF MICHIGAN, INC
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 07/18/2018
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Provider Practice Location Address
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Address Line | 2000 CENTERWOOD DR
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City | WARREN
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State | MI
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Zip | 48091
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Country | US
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Telephone | 313-832-8558
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Fax |
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Provider Business Mailing Address
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Address Line | 395 W LAKE ST
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City | ELMHURST
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State | IL
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Zip | 60126-1508
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Country | US
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Telephone | 630-538-1887
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Fax | 630-903-2835
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | KIMBERLY PATE GODDEN III
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Credential |
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Telephone | 630-903-2401
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416A0800X
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Taxonomy Name | Air Ambulance
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License Number | 501040
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 501040
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License Number State | MI
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