Provider Demographics
NPI:1649570177
Name:SUPERIOR PRIMARY CARE SERVICES LLC
Entity Type:Organization
Organization Name:SUPERIOR PRIMARY CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER-MGRM
Authorized Official - Prefix:MR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDWIRE
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:954-681-2881
Mailing Address - Street 1:7598 PINEWALK DR S
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-8122
Mailing Address - Country:US
Mailing Address - Phone:954-681-2881
Mailing Address - Fax:954-575-0000
Practice Address - Street 1:10284 NW 47TH ST
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7967
Practice Address - Country:US
Practice Address - Phone:954-681-2881
Practice Address - Fax:954-575-0000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty