Provider Demographics
NPI:1275626822
Name:HEALTHSOURCE, LLC
Entity Type:Organization
Organization Name:HEALTHSOURCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:EDMUNDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:412-226-9707
Mailing Address - Street 1:162 INDUSTRY DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15275-1014
Mailing Address - Country:US
Mailing Address - Phone:412-226-9707
Mailing Address - Fax:412-618-5477
Practice Address - Street 1:1000 HAMPTON CTR STE B
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-3315
Practice Address - Country:US
Practice Address - Phone:304-598-5975
Practice Address - Fax:304-598-0228
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810015828Medicaid
5833390001Medicare NSC