Provider Demographics
NPI:1982670923
Name:ONE SOURCE MEDICAL MANAGEMENT, INC.
Entity Type:Organization
Organization Name:ONE SOURCE MEDICAL MANAGEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:SATERFIEL
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:318-322-9252
Mailing Address - Street 1:PO BOX 2673
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71294-2673
Mailing Address - Country:US
Mailing Address - Phone:318-322-9252
Mailing Address - Fax:
Practice Address - Street 1:2933 CYPRESS ST STE 1
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291
Practice Address - Country:US
Practice Address - Phone:318-322-9252
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-28
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1443557Medicaid
LA1443557Medicaid