Provider Demographics
NPI:1063657286
Name:UP SUPERIOR ENTERPRISES, INC
Entity Type:Organization
Organization Name:UP SUPERIOR ENTERPRISES, INC
Other - Org Name:PRESCRIPTION OXYGEN SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-632-2772
Mailing Address - Street 1:2650 I-75 BUSINESS SPUR
Mailing Address - Street 2:
Mailing Address - City:SAULT STE. MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783
Mailing Address - Country:US
Mailing Address - Phone:906-632-3772
Mailing Address - Fax:906-632-0309
Practice Address - Street 1:13534 STATE HIGHWAY 28
Practice Address - Street 2:
Practice Address - City:NEWBERRY
Practice Address - State:MI
Practice Address - Zip Code:49868
Practice Address - Country:US
Practice Address - Phone:906-293-3556
Practice Address - Fax:906-293-8945
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies