Provider Demographics
NPI:1770921322
Name:SUPERIOR HEALTHCARE PHYSICAL MEDICINE
Entity type:Organization
Organization Name:SUPERIOR HEALTHCARE PHYSICAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VENUS
Authorized Official - Middle Name:I
Authorized Official - Last Name:PITTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:919-401-1999
Mailing Address - Street 1:3519 WITHERSPOON BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-6844
Mailing Address - Country:US
Mailing Address - Phone:919-401-1999
Mailing Address - Fax:919-401-1998
Practice Address - Street 1:3519 WITHERSPOON BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-6844
Practice Address - Country:US
Practice Address - Phone:919-401-1999
Practice Address - Fax:919-401-1998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-05
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6844310001Medicare NSC