Provider Demographics
NPI:1730544529
Name:SUPERIOR HEALTHCARE PHYSICAL MEDICINE OF HENDERSONVILLE, PC
Entity type:Organization
Organization Name:SUPERIOR HEALTHCARE PHYSICAL MEDICINE OF HENDERSONVILLE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GIOVANNI
Authorized Official - Middle Name:
Authorized Official - Last Name:LLIBRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-698-2688
Mailing Address - Street 1:1721 BREVARD ROAD
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-3201
Mailing Address - Country:US
Mailing Address - Phone:828-575-6244
Mailing Address - Fax:
Practice Address - Street 1:1721 BREVARD ROAD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-3201
Practice Address - Country:US
Practice Address - Phone:828-575-6244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty