Provider Demographics
NPI:1073511812
Name:ONE SOURCE INC.
Entity Type:Organization
Organization Name:ONE SOURCE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:228-875-3828
Mailing Address - Street 1:3004 BIENVILLE BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-4370
Mailing Address - Country:US
Mailing Address - Phone:228-875-3828
Mailing Address - Fax:
Practice Address - Street 1:3004 BIENVILLE BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-4370
Practice Address - Country:US
Practice Address - Phone:228-875-3828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS332B00000X
335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0440404Medicaid
MS0440404Medicaid