Provider Demographics
NPI:1043359730
Name:SUPERIOR MEDICAL SERVICES, LTD
Entity type:Organization
Organization Name:SUPERIOR MEDICAL SERVICES, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:NEMETH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-816-9296
Mailing Address - Street 1:225 E PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-2876
Mailing Address - Country:US
Mailing Address - Phone:847-816-9296
Mailing Address - Fax:847-816-9307
Practice Address - Street 1:225 E PARK AVE
Practice Address - Street 2:
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-2876
Practice Address - Country:US
Practice Address - Phone:847-816-9296
Practice Address - Fax:847-816-9307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207L00000X
IL2006N0192367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Not Answered367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0001621156OtherBCBS