Provider Demographics
NPI:1457919425
Name:NEW AGE LASER INC
Entity Type:Organization
Organization Name:NEW AGE LASER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LASER CONSULTANT TECHNICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:MERLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-547-5406
Mailing Address - Street 1:103 MEDICAL CENTER AVE
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-5423
Mailing Address - Country:US
Mailing Address - Phone:863-547-5406
Mailing Address - Fax:
Practice Address - Street 1:103 MEDICAL CENTER AVE
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-5423
Practice Address - Country:US
Practice Address - Phone:863-547-5406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty