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NPI Code Detail

MEDICARE: SUPERIOR AMBULANCE AVIATION, INC

MEDICARE: SUPERIOR AMBULANCE AVIATION, 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
1344800000XAir Carrier
23416A0800XAir Ambulance

General Provider Information

NPI Number : 1518558063
Entity Type Code : Organization
Provider Name (Legal Business Name) : SUPERIOR AMBULANCE AVIATION, 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 :
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 :
Authorized Official
Title or Position : AR MANAGER
Name : JONATHON MOLONEY
Credential :
Telephone Number : 630-903-2260
Provider Enumeration Date : 01/28/2021
Last Update Date : 01/28/2021

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