Provider Demographics
NPI:1720023286
Name:NEW HORIZONS MEDICAL SUPPLIES & EQUIPMENT
Entity Type:Organization
Organization Name:NEW HORIZONS MEDICAL SUPPLIES & EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LYNWOOD
Authorized Official - Middle Name:M
Authorized Official - Last Name:ELLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-230-7081
Mailing Address - Street 1:104 CHOWNING DR
Mailing Address - Street 2:SUITE 112
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-4900
Mailing Address - Country:US
Mailing Address - Phone:972-230-7081
Mailing Address - Fax:972-230-7075
Practice Address - Street 1:104 CHOWNING DR
Practice Address - Street 2:SUITE 112
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4900
Practice Address - Country:US
Practice Address - Phone:972-230-7081
Practice Address - Fax:972-230-7075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0073639332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164132602Medicaid
TX5104640001Medicare NSC