Provider Demographics
NPI:1265505879
Name:NEWSTYLE MEDICAL SUPPLIER INC.
Entity Type:Organization
Organization Name:NEWSTYLE MEDICAL SUPPLIER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GENNARO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-267-0100
Mailing Address - Street 1:7512 HWY 50
Mailing Address - Street 2:
Mailing Address - City:WEEPING WATER
Mailing Address - State:NE
Mailing Address - Zip Code:68463
Mailing Address - Country:US
Mailing Address - Phone:402-267-0100
Mailing Address - Fax:888-317-8778
Practice Address - Street 1:7512 HWY 50
Practice Address - Street 2:
Practice Address - City:WEEPING WATER
Practice Address - State:NE
Practice Address - Zip Code:68463
Practice Address - Country:US
Practice Address - Phone:402-267-0100
Practice Address - Fax:888-317-8778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2008-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025459300Medicaid
IA1265505879Medicaid
NE10025459300Medicaid