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General NPI Number Information
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NPI Number | 1851814560
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Entity Type | Organization
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Legal Business Name | SUPERIOR ACCESS AND HOME MODS
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Dates
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Enumeration Date | 07/25/2017
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Last Update Date | 07/25/2017
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Provider Practice Location Address
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Address Line | 406 WILLIAMSBURG AVE
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City | VICTORIA
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State | TX
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Zip | 77904
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Country | US
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Telephone | 361-571-9370
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Fax |
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Provider Business Mailing Address
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Address Line | 406 WILLIAMSBURG AVE
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City | VICTORIA
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State | TX
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Zip | 77904-2532
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | STEVEN MICHAEL DAVILA
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Credential |
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Telephone | 361-571-9370
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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 |
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License Number State |
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