Provider Demographics
NPI:1083750210
Name:SUPERIOR MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:SUPERIOR MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-230-5632
Mailing Address - Street 1:6025 LEE HIGHWAY
Mailing Address - Street 2:SUITE 431
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421
Mailing Address - Country:US
Mailing Address - Phone:931-551-9333
Mailing Address - Fax:931-551-8435
Practice Address - Street 1:1160 GALLATIN PIKE S STE 109
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:TN
Practice Address - Zip Code:37115
Practice Address - Country:US
Practice Address - Phone:615-865-3239
Practice Address - Fax:931-551-8435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000615332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90274275Medicaid
TN01359837OtherAMERIGROUP
TN1455279Medicaid
TN24521OtherCARECENTRIX
KY2444181000OtherPASSPORT ADVANTAGE
TNTN0101OtherAMERICHOICE
TN2377653OtherAETNA
TN4195118OtherBCBS
1954093OtherUNITED HEALTHCARE
KY50002684OtherPASSPORT HEALTH
=========OtherCOVENTRY HEALTHCARE
TN=========OtherGATEWAY HEALTH ALLIANCE
TN2377653OtherAETNA
TN4195118OtherBCBS
=========OtherSTERLING INSURANCE
TNTN0101OtherAMERICHOICE
1954093OtherUNITED HEALTHCARE
TN========= TNOtherHEALTH SCOPE
TN24521OtherCARECENTRIX