Organization
SUPERIOR AIR-GROUND AMBULANCE SERVICE OF INDIANA, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLY PATE GODDEN (CORPORATE SECRETARY)
(630) 832-2000
Entity
Organization
Contact information
Practice address
2605 GARFIELD AVE, HIGHLAND, IN 46322-1609
(830) 832-2000
Mailing address
395 W LAKE ST, ELMHURST, IL 60126-1508
(630) 832-2012
(630) 832-2169
Taxonomy
Speciality
Code
Description
License number
State
3416A0800X
Air Ambulance
0650
IN
3416L0300X
Land Ambulance
Primary
0650
IN
343900000X
Non-emergency Medical Transport (VAN)
0650
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2012654050A
—
IN
Enumeration date
09/13/2011
Last updated
02/20/2015
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