MEDICARE: SUPERIOR HEALTHCARE SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TP0016X	Prescribing (Medical) Psychologist		NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164721072
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERIOR HEALTHCARE SERVICES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 690547
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-7010
Country	:	US
Telephone Number	:	704-563-6262
Fax Number	:	704-563-6210

Provider Business Practice Location Address
First Line	:	6636 E WT HARRIS BLVD
Second Line	:	SUITE D - E
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-5133
Country	:	US
Telephone Number	:	704-563-6262
Fax Number	:	704-563-6210

Authorized Official
Title or Position	:	CEO
Name	:	MR. JASON CHRISTOPHER JONES
Credential	:
Telephone Number	:	704-563-6262

Provider Enumeration Date	:	03/17/2011
Last Update Date	:	03/17/2011

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