Provider Demographics
NPI:1770661803
Name:SUPERIOR VAN & MOBILITY
Entity Type:Organization
Organization Name:SUPERIOR VAN & MOBILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-458-8267
Mailing Address - Street 1:4734 ROCKFORD PLZ
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40216-2631
Mailing Address - Country:US
Mailing Address - Phone:800-458-8267
Mailing Address - Fax:502-447-5768
Practice Address - Street 1:3725 CLEVELAND ROAD EXT
Practice Address - Street 2:SUITE 400
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-9779
Practice Address - Country:US
Practice Address - Phone:574-271-1175
Practice Address - Fax:574-271-1546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN127842171WV0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171WV0202XOther Service ProvidersContractorVehicle ModificationsGroup - Multi-Specialty