Provider Demographics
NPI:1801855754
Name:SUPERIOR PROSTHETIC SOLUTIONS INC.
Entity Type:Organization
Organization Name:SUPERIOR PROSTHETIC SOLUTIONS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:J.
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:PINKSTON
Authorized Official - Suffix:
Authorized Official - Credentials:CPO/L
Authorized Official - Phone:859-491-0257
Mailing Address - Street 1:901 MONMOUTH ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:KY
Mailing Address - Zip Code:41071-2114
Mailing Address - Country:US
Mailing Address - Phone:859-491-0257
Mailing Address - Fax:859-491-4042
Practice Address - Street 1:901 MONMOUTH ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:KY
Practice Address - Zip Code:41071-2114
Practice Address - Country:US
Practice Address - Phone:859-491-0257
Practice Address - Fax:859-491-4042
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-20
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLPO 200335E00000X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90011255Medicaid
KY5056100001Medicare ID - Type UnspecifiedPROSTHETIC LAB