Provider Demographics
NPI:1982095634
Name:SUPERIOR MED DME, LLC
Entity Type:Organization
Organization Name:SUPERIOR MED DME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:YSBRAND
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:817-372-1719
Mailing Address - Street 1:320 REGAL ROW
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-5200
Mailing Address - Country:US
Mailing Address - Phone:972-557-7000
Mailing Address - Fax:972-557-7001
Practice Address - Street 1:320 REGAL ROW
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-5200
Practice Address - Country:US
Practice Address - Phone:972-557-7000
Practice Address - Fax:972-557-7001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX802151257332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies