Provider Demographics
NPI:1104821404
Name:NEW AGE PULMONARY SERVICES LLC
Entity type:Organization
Organization Name:NEW AGE PULMONARY SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:LIMBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:CRT
Authorized Official - Phone:502-458-6277
Mailing Address - Street 1:3040 BRECKENRIDGE LN
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-2194
Mailing Address - Country:US
Mailing Address - Phone:502-458-6277
Mailing Address - Fax:502-458-6858
Practice Address - Street 1:3040 BRECKENRIDGE LN
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-2194
Practice Address - Country:US
Practice Address - Phone:502-458-6277
Practice Address - Fax:502-458-6858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY145375332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000066987OtherANTHEM BCBS
IN200222400AMedicaid
KY90000282Medicaid
KY90000282Medicaid
IN200222400AMedicaid