Provider Demographics
NPI:1023028420
Name:SUPERIOR HOME MEDICAL
Entity Type:Organization
Organization Name:SUPERIOR HOME MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANDALA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-763-7993
Mailing Address - Street 1:605 S RIDGEWAY DR
Mailing Address - Street 2:
Mailing Address - City:BLYTHEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72315-8014
Mailing Address - Country:US
Mailing Address - Phone:770-763-7993
Mailing Address - Fax:
Practice Address - Street 1:1001 N 6TH ST STE B
Practice Address - Street 2:
Practice Address - City:BLYTHEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72315-1707
Practice Address - Country:US
Practice Address - Phone:870-762-5959
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies