Provider Demographics
NPI:1518558063
Name:SUPERIOR AMBULANCE AVIATION, INC
Entity Type:Organization
Organization Name:SUPERIOR AMBULANCE AVIATION, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AR MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHON
Authorized Official - Middle Name:
Authorized Official - Last Name:MOLONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-903-2260
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:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416A0800XTransportation ServicesAmbulanceAir Transport
No344800000XTransportation ServicesAir Carrier