Provider Demographics
NPI:1215934690
Name:NEW ABILITIES MEDICAL EQUIPMENT & SUPPLIES, INC.
Entity type:Organization
Organization Name:NEW ABILITIES MEDICAL EQUIPMENT & SUPPLIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:ATP, CRTS
Authorized Official - Phone:210-375-0003
Mailing Address - Street 1:10821 GULFDALE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-3608
Mailing Address - Country:US
Mailing Address - Phone:210-375-0003
Mailing Address - Fax:210-375-0009
Practice Address - Street 1:10821 GULFDALE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-3608
Practice Address - Country:US
Practice Address - Phone:210-375-0003
Practice Address - Fax:210-375-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-30
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0063893332B00000X, 332BC3200X, 332BP3500X, 332BX2000X
TX1004576332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX208011900OtherACS DEPARTMENT OF LABOR
TX531538OtherBLUE CROSS BLUE SHIELD
TX152911702OtherMOLINA HEALTHCARE
4516011OtherBRAVO HEALTHCARE
TX1529117-01Medicaid
TX1529117-02Medicaid
TX152911702Medicaid
TX10070285OtherAMERIGROUP COMMUNITY CARE
TX152911702OtherSUPERIOR HEALTH PLANS
TX152911702OtherSUPERIOR HEALTH PLANS
TX152911701Medicare ID - Type UnspecifiedMEDICAID CROSSOVERS