MEDICARE: SUPERIOR MONITORING ASSOCIATES LP

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	293D00000X	Physiological Laboratory

General Provider Information

NPI Number	:	1558546697
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERIOR MONITORING ASSOCIATES LP

Provider Business Mailing Address
First Line	:	4004 BELTLINE ROAD SUITE 207
Second Line	:	LOCKBOX 4
City	:	ADDISON
State	:	TX
Zip	:	75001
Country	:	US
Telephone Number	:	817-663-9514
Fax Number	:	817-379-0892

Provider Business Practice Location Address
First Line	:	4004 BELTLINE ROAD SUITE 207
Second Line	:	LOCKBOX 4
City	:	ADDISON
State	:	TX
Zip	:	75001-4370
Country	:	US
Telephone Number	:	817-663-9514
Fax Number	:	817-379-0892

Authorized Official
Title or Position	:	OWNER
Name	:	MR. RON C HATFIELD
Credential	:
Telephone Number	:	877-663-9514

Provider Enumeration Date	:	01/08/2008
Last Update Date	:	01/08/2008

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