Provider Demographics
NPI:1710669569
Name:SUPERIOR NEMT
Entity Type:Organization
Organization Name:SUPERIOR NEMT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:YOHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:GEDAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-355-8609
Mailing Address - Street 1:868 S 5TH ST APT 354
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-5970
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:868 S 5TH ST APT 354
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-5970
Practice Address - Country:US
Practice Address - Phone:408-355-8609
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle