Provider Demographics
NPI:1972303089
Name:SUPERIOR MEDICAL SERVICE, PLLC
Entity type:Organization
Organization Name:SUPERIOR MEDICAL SERVICE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:RICK
Authorized Official - Suffix:
Authorized Official - Credentials:AGNP-C
Authorized Official - Phone:208-936-1418
Mailing Address - Street 1:10323 COLORFUL DR
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83687-5163
Mailing Address - Country:US
Mailing Address - Phone:208-936-1418
Mailing Address - Fax:
Practice Address - Street 1:10323 COLORFUL DR
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-5163
Practice Address - Country:US
Practice Address - Phone:208-936-1418
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-17
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care