Provider Demographics
NPI:1134479868
Name:SUPERIOR DRIVERS, LLC
Entity Type:Organization
Organization Name:SUPERIOR DRIVERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:O
Authorized Official - Last Name:BODEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-681-9935
Mailing Address - Street 1:2620 CENTENARY BLVD
Mailing Address - Street 2:SUITE 312
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71104-3356
Mailing Address - Country:US
Mailing Address - Phone:318-681-9935
Mailing Address - Fax:318-681-9938
Practice Address - Street 1:2620 CENTENARY BLVD
Practice Address - Street 2:SUITE 312
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71104-3356
Practice Address - Country:US
Practice Address - Phone:318-681-9935
Practice Address - Fax:318-681-9938
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-10
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)