Provider Demographics
NPI:1780871202
Name:SUPER ADVANCE SERVICES INC.
Entity type:Organization
Organization Name:SUPER ADVANCE SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATERNINA
Authorized Official - Middle Name:
Authorized Official - Last Name:OSCAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-465-6763
Mailing Address - Street 1:8181 NW 36TH ST
Mailing Address - Street 2:SUITE #1006
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33166-6671
Mailing Address - Country:US
Mailing Address - Phone:954-465-6763
Mailing Address - Fax:
Practice Address - Street 1:8181 NW 36TH ST
Practice Address - Street 2:SUITE #1006
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6671
Practice Address - Country:US
Practice Address - Phone:954-465-6763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2008-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6011540001Medicare NSC