Healthcare Provider Details

I. General information

NPI: 1669470282
Provider Name (Legal Business Name): A NEW IMAGE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 HEATH ST
WATERLOO IA
50703-1930
US

IV. Provider business mailing address

1607 HEATH ST
WATERLOO IA
50703-1930
US

V. Phone/Fax

Practice location:
  • Phone: 319-232-3219
  • Fax:
Mailing address:
  • Phone: 319-232-3219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: BARBARA A DANIELS
Title or Position: PRESIDENT
Credential:
Phone: 319-232-3219