Superior Outpatient Center LLC

Primary specialty

Community/Behavioral Health AgencyTaxonomy code 251S00000X

Legal business name

SUPERIOR OUTPATIENT CENTER LLC

Practice address

3201 W Peoria Ave Ste B408
Phoenix, AZ 85029-4610

Phone

(612) 306-0639

NPI assigned

Jun 20, 2023

Last updated

Jun 20, 2023By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Abdisaak Mohamud

Title

Owner

Phone

(612) 306-0639

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1687219200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1687219200000",
    "number": "1487339123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5545 W WALATOWA ST",
            "city": "LAVEEN",
            "state": "AZ",
            "postal_code": "853395498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3201 W PEORIA AVE STE B408",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850294610",
            "telephone_number": "612-306-0639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERIOR OUTPATIENT CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-06-20",
        "last_updated": "2023-06-20",
        "certification_date": "2023-06-20",
        "status": "A",
        "authorized_official_last_name": "MOHAMUD",
        "authorized_official_first_name": "ABDISAAK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "612-306-0639",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AZDHS",
            "identifier": "OTC12666",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.