Organization Name: | SOURCEONE MEDICAL INC |
NPI Number: | 1982679056 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DEBRA JANSSEN (ADM OFFICE MANAGER) |
Mailing Address: | 167 W 7065 S Midvale |
State: | UT US |
Postal Code: | 840473717 |
Phone Number: | 8013070758 |
Fax Number: | 8013070765 |
NPI Enumeration Date: | 02/21/2006 |
NPI Last Update Date: | 07/09/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 332B00000X |
License Number: | 602330-1714 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | UT |
Taxonomy Type: | Suppliers |
Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
Taxonomy Specialization: | |
Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |