Provider Demographics
NPI:1386886265
Name:SUPERIOR HEALTHCARE, PLLC
Entity type:Organization
Organization Name:SUPERIOR HEALTHCARE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:931-905-1720
Mailing Address - Street 1:2269 WILMA RUDOLPH BLVD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-3179
Mailing Address - Country:US
Mailing Address - Phone:931-905-1720
Mailing Address - Fax:931-905-1721
Practice Address - Street 1:2269 WILMA RUDOLPH BLVD
Practice Address - Street 2:SUITE 107
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-3179
Practice Address - Country:US
Practice Address - Phone:931-905-1720
Practice Address - Fax:931-905-1721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-24
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDC0000002132111N00000X
TNMD45045207RS0010X
TNAPN0000012014363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1513752Medicaid
TNDO8673OtherRAILROAD MEDICARE
TN3373593Medicare PIN
TN1513752Medicaid