Provider Demographics
NPI:1205123874
Name:ONE SOURCE MEDICAL SUPPLY LLC
Entity type:Organization
Organization Name:ONE SOURCE MEDICAL SUPPLY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-258-7080
Mailing Address - Street 1:1829 PARK LN S
Mailing Address - Street 2:SUITE 8 & 9
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-8086
Mailing Address - Country:US
Mailing Address - Phone:888-258-7080
Mailing Address - Fax:888-881-5950
Practice Address - Street 1:1829 PARK LN S
Practice Address - Street 2:SUITE 8 & 9
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33458-8086
Practice Address - Country:US
Practice Address - Phone:888-258-7080
Practice Address - Fax:888-881-5950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5278560001Medicare NSC