Provider Demographics
NPI:1558793091
Name:SUPERIOR HEALTHCARE OF BAKERSFIELD
Entity Type:Organization
Organization Name:SUPERIOR HEALTHCARE OF BAKERSFIELD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:J
Authorized Official - Last Name:FOSBINDER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:661-836-2226
Mailing Address - Street 1:5500 MING AVE
Mailing Address - Street 2:SUITE 170
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-4689
Mailing Address - Country:US
Mailing Address - Phone:661-836-2226
Mailing Address - Fax:661-836-2223
Practice Address - Street 1:5500 MING AVE
Practice Address - Street 2:SUITE 170
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-4689
Practice Address - Country:US
Practice Address - Phone:661-836-2226
Practice Address - Fax:661-836-2223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-07
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA111N00000X
CA20A9214261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH99943Medicare UPIN