Provider Demographics
NPI:1104364520
Name:SUPERIOR TRANSPORTATION, LLC
Entity Type:Organization
Organization Name:SUPERIOR TRANSPORTATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-680-7697
Mailing Address - Street 1:PO BOX 8121
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71148-8121
Mailing Address - Country:US
Mailing Address - Phone:318-680-7697
Mailing Address - Fax:318-635-7499
Practice Address - Street 1:6504 HEARNE AVE
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71108-4520
Practice Address - Country:US
Practice Address - Phone:318-680-7697
Practice Address - Fax:318-635-7499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)