Superior Sports Medicine LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

000878433 Issued in NC

Legal business name

SUPERIOR SPORTS MEDICINE LLC

Practice address

175 Towerview Court
Cary, NC 27513

Phone

(919) 459-4135

Fax

(919) 882-1247

NPI assigned

Sep 27, 2005

Last updated

Apr 16, 2009By 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. Gregory C Federico, ORTHOTIC FITTER

Title

Manager

Phone

(919) 459-4135

Specialties & licenses 2

Addresses

Locations

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

{
    "created_epoch": "1127779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1239840000000",
    "number": "1720075450",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 880",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275120880",
            "telephone_number": "919-459-4135",
            "fax_number": "919-882-1247"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "175 TOWERVIEW COURT",
            "city": "CARY",
            "state": "NC",
            "postal_code": "27513",
            "telephone_number": "919-459-4135",
            "fax_number": "919-882-1247"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUPERIOR SPORTS MEDICINE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-27",
        "last_updated": "2009-04-16",
        "status": "A",
        "authorized_official_last_name": "FEDERICO",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "919-459-4135",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "ORTHOTIC FITTER"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NC",
            "license": "000878433",
            "primary": true
        },
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": "NC",
            "license": "00811",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2009; 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.