Provider Demographics
NPI:1538343157
Name:SUPERIOR VAN & MOBILITY, LLC
Entity type:Organization
Organization Name:SUPERIOR VAN & MOBILITY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-419-4925
Mailing Address - Street 1:12329 INDUSTRIPLEX BLVD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-5125
Mailing Address - Country:US
Mailing Address - Phone:225-663-8830
Mailing Address - Fax:225-410-7328
Practice Address - Street 1:12329 INDUSTRIPLEX BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-5125
Practice Address - Country:US
Practice Address - Phone:225-663-8830
Practice Address - Fax:225-410-7328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-18
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1463949Medicaid