MEDICARE: SUPERIOR DME 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	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	530857	OTHER	TN	BLUE CROSS BLUE SHIELD-TX

General Provider Information

NPI Number	:	1578694568
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERIOR DME INC

Provider Business Mailing Address
First Line	:	4930 OSBORNE DR
Second Line	:	SUITE G
City	:	EL PASO
State	:	TX
Zip	:	79922-1041
Country	:	US
Telephone Number	:	915-581-3772
Fax Number	:	915-581-3199

Provider Business Practice Location Address
First Line	:	4930 OSBORNE DR
Second Line	:	SUITE G
City	:	EL PASO
State	:	TX
Zip	:	79922-1041
Country	:	US
Telephone Number	:	915-581-3772
Fax Number	:	915-581-3199

Authorized Official
Title or Position	:	OWNER
Name	:	PROF. ROBERT MARTINEZ
Credential	:
Telephone Number	:	915-581-3772

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	04/20/2008

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