MEDICARE: SUPERIOR VAN & MOBILITY

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	171WV0202X	Vehicle Modifications Contractor	127842	IN

General Provider Information

NPI Number	:	1770661803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERIOR VAN & MOBILITY

Provider Business Mailing Address
First Line	:	1506 LAKE SHORE CT
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40223-3803
Country	:	US
Telephone Number	:	800-458-8267
Fax Number	:	866-457-0453

Provider Business Practice Location Address
First Line	:	4246 MEGHAN BEELER CT STE 1
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46628-8459
Country	:	US
Telephone Number	:	574-271-1175
Fax Number	:	866-850-5638

Authorized Official
Title or Position	:	VICE PRESIDENT OF OPERATIONS
Name	:	ERIN ENGELAU
Credential	:
Telephone Number	:	317-353-3818

Provider Enumeration Date	:	11/02/2006
Last Update Date	:	02/03/2026

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