Provider Demographics
NPI:1578694568
Name:SUPERIOR DME INC
Entity Type:Organization
Organization Name:SUPERIOR DME INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:PROF
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-581-3772
Mailing Address - Street 1:4930 OSBORNE DR
Mailing Address - Street 2:SUITE G
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79922-1041
Mailing Address - Country:US
Mailing Address - Phone:915-581-3772
Mailing Address - Fax:915-581-3199
Practice Address - Street 1:4930 OSBORNE DR
Practice Address - Street 2:SUITE G
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79922-1041
Practice Address - Country:US
Practice Address - Phone:915-581-3772
Practice Address - Fax:915-581-3199
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUPERIOR DME, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-08
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN530857OtherBLUE CROSS BLUE SHIELD-TX
TX=========-2OtherTAX ID
TN530857OtherBLUE CROSS BLUE SHIELD-TX