Provider Demographics
NPI:1891728549
Name:SUPERIOR MEDICAL SUPPLY L.L.C.
Entity Type:Organization
Organization Name:SUPERIOR MEDICAL SUPPLY L.L.C.
Other - Org Name:SUPERIOR MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-592-0699
Mailing Address - Street 1:P.O. BOX 472
Mailing Address - Street 2:
Mailing Address - City:HULL
Mailing Address - State:TX
Mailing Address - Zip Code:77564
Mailing Address - Country:US
Mailing Address - Phone:281-385-5413
Mailing Address - Fax:281-576-5433
Practice Address - Street 1:202 S SAN JACINTO AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TX
Practice Address - Zip Code:77327-4413
Practice Address - Country:US
Practice Address - Phone:281-592-0699
Practice Address - Fax:281-592-0422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX5646610001Medicare NSC