Provider Demographics
NPI:1912035759
Name:NEW YOU
Entity Type:Organization
Organization Name:NEW YOU
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:O'CONNOR
Authorized Official - Last Name:MCCLARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-685-2001
Mailing Address - Street 1:1725 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1150
Mailing Address - Country:US
Mailing Address - Phone:270-685-2001
Mailing Address - Fax:270-685-2000
Practice Address - Street 1:1725 E 18TH ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1150
Practice Address - Country:US
Practice Address - Phone:270-685-2001
Practice Address - Fax:270-685-2000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY90450305Medicaid
IN200124680Medicaid
000000211325OtherANTHEM
KY1306870001Medicare ID - Type Unspecified