Provider Demographics
NPI:1407132210
Name:SUPERIOR LAB INC
Entity Type:Organization
Organization Name:SUPERIOR LAB INC
Other - Org Name:SUPERIOR LAB SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-512-7206
Mailing Address - Street 1:4840 164TH AVE N
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33762-3231
Mailing Address - Country:US
Mailing Address - Phone:727-492-0545
Mailing Address - Fax:727-530-3513
Practice Address - Street 1:4840 164TH AVE N
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33762-3231
Practice Address - Country:US
Practice Address - Phone:727-492-0545
Practice Address - Fax:727-530-3513
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP06000053366171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty