Provider Demographics
NPI:1275740318
Name:UP SUPERIOR ENTERPRISES INC
Entity Type:Organization
Organization Name:UP SUPERIOR ENTERPRISES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:906-632-6736
Mailing Address - Street 1:2675 ASHMUN ST
Mailing Address - Street 2:
Mailing Address - City:SAULT SAINTE MARIE
Mailing Address - State:MI
Mailing Address - Zip Code:49783-3711
Mailing Address - Country:US
Mailing Address - Phone:906-632-3772
Mailing Address - Fax:906-632-0309
Practice Address - Street 1:2303 ASHMUN ST
Practice Address - Street 2:
Practice Address - City:SAULT SAINTE MARIE
Practice Address - State:MI
Practice Address - Zip Code:49783-3749
Practice Address - Country:US
Practice Address - Phone:906-632-3772
Practice Address - Fax:906-632-0309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI00194T332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1275740318Medicaid
MI540A70445OtherBLUE CROSS AND BLUE SHIELD
MI6075410001Medicare NSC