=====================================================
General NPI Number Information
=====================================================
NPI Number | 1043200801
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW AGE MEDICAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/24/2005
-----------------------------------------------------
Last Update Date | 08/06/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15342 HAWTHORNE BLVD SUITE 206
-----------------------------------------------------
City | LAWNDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90260-2152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-676-9383
-----------------------------------------------------
Fax | 310-644-0652
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15342 HAWTHORNE BLVD SUITE 206
-----------------------------------------------------
City | LAWNDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90260-2152
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-676-9383
-----------------------------------------------------
Fax | 310-644-0652
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER CEO
-----------------------------------------------------
Name | MR. FRANCIS IHEMADU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 310-676-9383
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 101131
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------