Provider Demographics
NPI:1235312927
Name:SUPERIOR VAN & MOBILITY, LLC
Entity Type:Organization
Organization Name:SUPERIOR VAN & MOBILITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-419-4925
Mailing Address - Street 1:1901 WESTBANK EXPRESSWAY
Mailing Address - Street 2:SUITE 500
Mailing Address - City:HARVEY
Mailing Address - State:LA
Mailing Address - Zip Code:70058-4373
Mailing Address - Country:US
Mailing Address - Phone:504-684-2100
Mailing Address - Fax:504-491-9174
Practice Address - Street 1:1901 WESTBANK EXPRESSWAY
Practice Address - Street 2:SUITE 500
Practice Address - City:HARVEY
Practice Address - State:LA
Practice Address - Zip Code:70058-4373
Practice Address - Country:US
Practice Address - Phone:504-684-2100
Practice Address - Fax:504-491-9174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1720166853Medicaid
IN1306924733Medicaid
LA1721395Medicaid