MEDICARE: SUPERB WAY 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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1992553994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUPERB WAY INC

Provider Business Mailing Address
First Line	:	2623 GERMANTOWN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133-1618
Country	:	US
Telephone Number	:	800-789-4020
Fax Number	:	800-789-4020

Provider Business Practice Location Address
First Line	:	2623 GERMANTOWN AVE
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19133-1618
Country	:	US
Telephone Number	:	800-789-4020
Fax Number	:	800-789-4020

Authorized Official
Title or Position	:	CFO
Name	:	CRAIG MYERS
Credential	:
Telephone Number	:	484-609-3818

Provider Enumeration Date	:	05/07/2024
Last Update Date	:	08/06/2024

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