Provider Demographics
NPI:1558679423
Name:MEDICAL SUPER CENTER
Entity type:Organization
Organization Name:MEDICAL SUPER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-470-9700
Mailing Address - Street 1:5246 S 40TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85040-9009
Mailing Address - Country:US
Mailing Address - Phone:602-470-9700
Mailing Address - Fax:602-454-6306
Practice Address - Street 1:6704 E BROADWAY RD
Practice Address - Street 2:D4
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-1724
Practice Address - Country:US
Practice Address - Phone:480-924-5914
Practice Address - Fax:480-924-5984
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDASSURE INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-14
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies