Provider Demographics
NPI:1366500548
Name:NEW LIFE MEDICAL SUPPLIES INC
Entity Type:Organization
Organization Name:NEW LIFE MEDICAL SUPPLIES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:R
Authorized Official - Last Name:BIGGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-224-1941
Mailing Address - Street 1:1601 OSPREY DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-8818
Mailing Address - Country:US
Mailing Address - Phone:972-224-1941
Mailing Address - Fax:972-224-4395
Practice Address - Street 1:1601 OSPREY DR
Practice Address - Street 2:SUITE 101
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-8818
Practice Address - Country:US
Practice Address - Phone:972-224-1941
Practice Address - Fax:972-224-4395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-04
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0083711332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX179062801Medicaid
TX5549280001Medicare ID - Type Unspecified