Provider Demographics
NPI:1669470282
Name:A NEW IMAGE, INC.
Entity type:Organization
Organization Name:A NEW IMAGE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:319-232-3219
Mailing Address - Street 1:1607 HEATH ST
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50703-1930
Mailing Address - Country:US
Mailing Address - Phone:319-232-3219
Mailing Address - Fax:
Practice Address - Street 1:1607 HEATH ST
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50703-1930
Practice Address - Country:US
Practice Address - Phone:319-232-3219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0248278Medicaid
IA09017OtherIOWA BLUE CROSS BLUE SHIE
IA0248278Medicaid