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NPI Code Detail

MEDICARE: SUPERIOR AIR-GROUND AMBULANCE SERVICE, INC

MEDICARE: SUPERIOR AIR-GROUND AMBULANCE SERVICE, 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
13416L0300XLand Ambulance1690746 8-7213IL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
101690046OTHERILBLUECROSS BLUESHIELD
2000000517875OTHERINANTHEM BC/BS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1336107838
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUPERIOR AIR-GROUND AMBULANCE SERVICE, INC
Provider Business Mailing Address
First Line : 395 W LAKE ST
Second Line :
City : ELMHURST
State : IL
Zip : 60126-1508
Country : US
Telephone Number : 630-832-2012
Fax Number : 630-832-2169
Provider Business Practice Location Address
First Line : 395 W LAKE ST
Second Line :
City : ELMHURST
State : IL
Zip : 60126-1508
Country : US
Telephone Number : 630-832-2012
Fax Number : 630-832-2169
Authorized Official
Title or Position : PRESIDENT
Name : MR. DAVID B. HILL III
Credential :
Telephone Number : 630-832-2012
Provider Enumeration Date : 05/03/2006
Last Update Date : 07/14/2014

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