Provider Demographics
NPI:1477887966
Name:SUPERIOR MEDICAL TRANSPORTATION INC
Entity Type:Organization
Organization Name:SUPERIOR MEDICAL TRANSPORTATION INC
Other - Org Name:SUPERIOR MEDICAL TRANSPORTATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SPARTAK
Authorized Official - Middle Name:
Authorized Official - Last Name:PETOYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-640-3231
Mailing Address - Street 1:11755 VICTORY BLVD
Mailing Address - Street 2:SUITE 100C
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3423
Mailing Address - Country:US
Mailing Address - Phone:818-980-9080
Mailing Address - Fax:818-980-9081
Practice Address - Street 1:11755 VICTORY BLVD
Practice Address - Street 2:SUITE 100C
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3423
Practice Address - Country:US
Practice Address - Phone:818-980-9080
Practice Address - Fax:818-980-9081
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-30
Last Update Date:2009-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABT-63215343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)