Provider Demographics
NPI:1689883209
Name:SUPERIOR SOURCE INC
Entity Type:Organization
Organization Name:SUPERIOR SOURCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:OLANDUS
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-568-4785
Mailing Address - Street 1:78 WESTMINISTER DR
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72209-2949
Mailing Address - Country:US
Mailing Address - Phone:501-568-4785
Mailing Address - Fax:501-562-0603
Practice Address - Street 1:78 WESTMINISTER DR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72209-2949
Practice Address - Country:US
Practice Address - Phone:501-568-4785
Practice Address - Fax:501-562-0603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty