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Organization
SUPERIOR AIR-GROUND AMBULANCE SERVICE OF MICHIGAN, INC
Active
Organization
SUPERIOR AIR-GROUND AMBULANCE SERVICE OF MICHIGAN, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY PATE GODDEN III (VICE PRESIDENT)
(630) 903-2401
Entity
Organization
Contact information
Practice address
2000 CENTERWOOD DR, WARREN, MI 48091
(313) 832-8558
Mailing address
395 W LAKE ST, ELMHURST, IL 60126-1508
(630) 538-1887
(630) 903-2835
Taxonomy
Speciality
Code
Description
License number
State
3416A0800X
Air Ambulance
501040
MI
3416L0300X
Land Ambulance
Primary
501040
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
058738
HAP(HEALTH ALLIANCE PLAN)
MI
01
—
0E01788
BLUECROSS BLUESHIELD
MI
05
—
188077058
—
MI
Enumeration date
05/03/2006
Last updated
07/18/2018
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