Provider Demographics
NPI:1144393448
Name:SUPERIOR AMBULANCE SERVICE, INC.
Entity Type:Organization
Organization Name:SUPERIOR AMBULANCE SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:L
Authorized Official - Last Name:DICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-458-6301
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-0247
Mailing Address - Country:US
Mailing Address - Phone:724-458-5350
Mailing Address - Fax:724-458-6302
Practice Address - Street 1:921 EAST MAIN STREET EXT.
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-0247
Practice Address - Country:US
Practice Address - Phone:724-458-5350
Practice Address - Fax:724-458-6302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA022383416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016173000002Medicaid
293270Medicare ID - Type Unspecified