Provider Demographics
NPI:1356328322
Name:A SUPERIOR AMBULANCE PROVIDER LLC
Entity Type:Organization
Organization Name:A SUPERIOR AMBULANCE PROVIDER LLC
Other - Org Name:ASAP AMBULANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-428-0060
Mailing Address - Street 1:116 MASON STREET
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39442-2727
Mailing Address - Country:US
Mailing Address - Phone:601-428-0060
Mailing Address - Fax:601-425-3795
Practice Address - Street 1:116 MASON STREET
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39442-2727
Practice Address - Country:US
Practice Address - Phone:601-428-0060
Practice Address - Fax:601-425-3795
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS2703416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00551589Medicaid
MS590000071Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER