Source 1

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

License

4274647 Issued in CO

Legal business name

SOURCE 1

Doing business as

Source 1 - DME

Practice address

1615 Foxtrail Dr Ste 190
Loveland, CO 80538-9087

Phone

(303) 952-0396

Fax

(303) 595-5262

NPI assigned

Nov 9, 2009

Last updated

Nov 9, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Tracy John Fox

Title

Business Owner

Phone

(303) 952-0396

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Source 1 - DME Doing business as

Tax ID family

Source 14 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Source 1

  dba Flatirons Sports medicine or Source 1-DME

  • Customized Equipment (DME)
  • Louisville, CO
  • NPI 1578896502
  NPD tax ID
• Source 1

  dba flatirons sports medicine or Source 1- DME

  • Customized Equipment (DME)
  • Superior, CO
  • NPI 1609109776
  NPD tax ID
• Source 1

  dba Flatirons sports medicine or Source 1-DME

  • Customized Equipment (DME)
  • Wheat Ridge, CO
  • NPI 1821321860
  NPD tax ID

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1257724800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1257724800000",
    "number": "1063749265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3012 MICA CT",
            "city": "SUPERIOR",
            "state": "CO",
            "postal_code": "800274548",
            "telephone_number": "303-952-0396",
            "fax_number": "303-595-5262"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1615 FOXTRAIL DR STE 190",
            "city": "LOVELAND",
            "state": "CO",
            "postal_code": "805389087",
            "telephone_number": "303-952-0396",
            "fax_number": "303-595-5262"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOURCE 1",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-09",
        "last_updated": "2009-11-09",
        "status": "A",
        "authorized_official_last_name": "FOX",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "BUSINESS OWNER",
        "authorized_official_telephone_number": "303-952-0396",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "CO",
            "license": "4274647",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "38059525",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Source 1 - DME",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Irene L Sokolowski, MD
• Solstice Counseling LLC
• Katherine Alice Somodi-Stephenson, MD
• David Sorensen, RN
• Michelle L Soriano, MD
• Sovereignty Counseling Services, PLLC (Sovereignty Counseling Services)
• Amanda J Spaak, NP
• Amanda Spanbauer, LPC
• Alaina Spangenberger
• Specialty Counseling & Consulting

• Customized Equipment (DME) in Loveland, CO
• Providers in Loveland, CO by specialty
• Customized Equipment (DME) in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.