# SUPERIOR AIR-GROUND AMBULANCE SERVICE OF MICHIGAN, INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1720046188
- **Authorized official:** KIMBERLY PATE GODDEN III (VICE PRESIDENT)
- **Authorized official phone:** (630) 903-2401

## Contact information

- **Practice address:** 2000 CENTERWOOD DR, WARREN, MI 48091
- **Practice address phone:** (313) 832-8558
- **Mailing address:** 395 W LAKE ST, ELMHURST, IL 60126-1508
- **Mailing address phone:** (630) 538-1887
- **Mailing address fax:** (630) 903-2835

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 3416A0800X | Air Ambulance | 501040 | MI | — |
| 3416L0300X | Land Ambulance | 501040 | MI | Yes |

## Other

- **Enumeration date:** 05/03/2006
- **Last updated:** 07/18/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 058738 | HAP(HEALTH ALLIANCE PLAN) | MI |
| 01 | — | 0E01788 | BLUECROSS BLUESHIELD | MI |
| 05 | — | 188077058 | — | MI |