Provider Demographics
NPI:1053598219
Name:ELAINE R. MEISNER , SUPERIOR MEDICAL SERVICES
Entity type:Organization
Organization Name:ELAINE R. MEISNER , SUPERIOR MEDICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:R
Authorized Official - Last Name:MEISNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-522-6373
Mailing Address - Street 1:19455 COUNTY ROAD 36
Mailing Address - Street 2:
Mailing Address - City:STERLING
Mailing Address - State:CO
Mailing Address - Zip Code:80751-9349
Mailing Address - Country:US
Mailing Address - Phone:970-522-6373
Mailing Address - Fax:
Practice Address - Street 1:19455 COUNTY ROAD 36
Practice Address - Street 2:
Practice Address - City:STERLING
Practice Address - State:CO
Practice Address - Zip Code:80751-9349
Practice Address - Country:US
Practice Address - Phone:970-522-6373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO08002271Medicaid
CO=========OtherFED TAX ID