Provider Demographics
NPI:1700024049
Name:NEWAGE SA CORP
Entity Type:Organization
Organization Name:NEWAGE SA CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIDGEON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-418-7555
Mailing Address - Street 1:2223 SW 13TH AVE
Mailing Address - Street 2:# 300
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33145-3920
Mailing Address - Country:US
Mailing Address - Phone:305-418-7555
Mailing Address - Fax:
Practice Address - Street 1:2223 SW 13TH AVE
Practice Address - Street 2:# 300
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33145-3920
Practice Address - Country:US
Practice Address - Phone:305-418-7555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-24
Last Update Date:2009-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization