Provider Demographics
NPI:1497009112
Name:SUPERIOR MEDICAL EQUIPMENT GROUP, INC.
Entity type:Organization
Organization Name:SUPERIOR MEDICAL EQUIPMENT GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:ROUEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-461-4675
Mailing Address - Street 1:PO BOX 1747
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21041-1747
Mailing Address - Country:US
Mailing Address - Phone:410-461-4675
Mailing Address - Fax:410-461-5424
Practice Address - Street 1:59 N. 7TH STREET
Practice Address - Street 2:
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201-2746
Practice Address - Country:US
Practice Address - Phone:717-709-4731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-02
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD335E00000X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD193728600Medicaid
MD193728600Medicaid