Provider Demographics
NPI:1336107838
Name:SUPERIOR AIR-GROUND AMBULANCE SERVICE, INC
Entity Type:Organization
Organization Name:SUPERIOR AIR-GROUND AMBULANCE SERVICE, INC
Other - Org Name:SUPERIOR AMBULANCE SERVICE, INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:HILL
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:630-832-2012
Mailing Address - Street 1:395 W LAKE ST
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-1508
Mailing Address - Country:US
Mailing Address - Phone:630-832-2012
Mailing Address - Fax:630-832-2169
Practice Address - Street 1:395 W LAKE ST
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-1508
Practice Address - Country:US
Practice Address - Phone:630-832-2012
Practice Address - Fax:630-832-2169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-03
Last Update Date:2014-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1690746 8-72133416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01690046OtherBLUECROSS BLUESHIELD
IN000000517875OtherANTHEM BC/BS
MI188077058Medicaid
IN100030530BMedicaid
IN000000517875OtherANTHEM BC/BS
IL01690046OtherBLUECROSS BLUESHIELD
IN150110Medicare ID - Type Unspecified
MI188077058Medicaid
IL=========001Medicaid