Provider Demographics
NPI:1063167054
Name:SUPERIOR PROVIDER SERVICES
Entity type:Organization
Organization Name:SUPERIOR PROVIDER SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTARTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DIEGO
Authorized Official - Middle Name:
Authorized Official - Last Name:QUIJANO
Authorized Official - Suffix:JR
Authorized Official - Credentials:EMT
Authorized Official - Phone:956-240-4351
Mailing Address - Street 1:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78573-0009
Mailing Address - Country:US
Mailing Address - Phone:956-793-7702
Mailing Address - Fax:956-519-0660
Practice Address - Street 1:848 EAST EXPRESSWAY 83
Practice Address - Street 2:
Practice Address - City:LA JOYA
Practice Address - State:TX
Practice Address - Zip Code:78560-4252
Practice Address - Country:US
Practice Address - Phone:956-793-7702
Practice Address - Fax:956-519-0660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-17
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care