Provider Demographics
NPI:1033642053
Name:A NEW WAY TO GO DME SUPPLY, INC.
Entity Type:Organization
Organization Name:A NEW WAY TO GO DME SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LETITIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-686-7660
Mailing Address - Street 1:17500 E CARRIAGEWAY DRIVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:HAZEL CREST
Mailing Address - State:IL
Mailing Address - Zip Code:60429-3014
Mailing Address - Country:US
Mailing Address - Phone:702-686-7660
Mailing Address - Fax:708-360-6171
Practice Address - Street 1:960 GOLF CT
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-5245
Practice Address - Country:US
Practice Address - Phone:702-686-7660
Practice Address - Fax:888-286-7476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-06
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies