MEDICARE: SUPERIOR EMS 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	3416L0300X	Land Ambulance	1000410	TX

General Provider Information

NPI Number	:	1255650180
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERIOR EMS INC.

Provider Business Mailing Address
First Line	:	PO BOX 840528
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77284-0528
Country	:	US
Telephone Number	:	281-858-7200
Fax Number	:	281-550-7985

Provider Business Practice Location Address
First Line	:	4994 HIGHWAY 6 N STE D
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77084-5283
Country	:	US
Telephone Number	:	832-741-7782
Fax Number	:	281-550-7985

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. ABIMBOLA AGBETOLA
Credential	:	DIRECTOR
Telephone Number	:	832-741-7782

Provider Enumeration Date	:	05/17/2010
Last Update Date	:	05/27/2010

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