Provider Demographics
NPI:1265612782
Name:ONE SOURCE MEDICAL SERVICE, INC
Entity type:Organization
Organization Name:ONE SOURCE MEDICAL SERVICE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:HERRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:407-936-0091
Mailing Address - Street 1:PO BOX 912
Mailing Address - Street 2:
Mailing Address - City:GOTHA
Mailing Address - State:FL
Mailing Address - Zip Code:34734-0912
Mailing Address - Country:US
Mailing Address - Phone:407-936-0091
Mailing Address - Fax:407-936-1182
Practice Address - Street 1:1209 E 2ND ST
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1413
Practice Address - Country:US
Practice Address - Phone:407-936-0091
Practice Address - Fax:407-936-1182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1293332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3977000001Medicare NSC