Life Source Medical, Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

LIFE SOURCE MEDICAL, INC.

Practice address

377 S Swing Rd
Greensboro, NC 27409-2009

Phone

(336) 316-1166

Fax

(336) 316-1144

NPI assigned

Jul 28, 2007

Organization subpart

No

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

Authorized official

Name

Ms. Gorgi Naumovski

Title

VP President

Phone

(618) 571-1005

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Rick Dean Puckett, C.PED

  • Prosthetic/Orthotic Supplier
  • Greensboro, NC
  • NPI 1356506125
  NPD (past)

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

{
    "created_epoch": "1185580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1474416000000",
    "number": "1083804785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "377 S SWING RD",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274092009",
            "telephone_number": "336-316-1166",
            "fax_number": "336-316-1144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "377 S SWING RD",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274092009",
            "telephone_number": "336-316-1166",
            "fax_number": "336-316-1144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE SOURCE MEDICAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-28",
        "last_updated": "2016-09-21",
        "status": "A",
        "authorized_official_last_name": "NAUMOVSKI",
        "authorized_official_first_name": "GORGI",
        "authorized_official_title_or_position": "VP PRESIDENT",
        "authorized_official_telephone_number": "618-571-1005",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NC",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7704697",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Life Champions, LLC
• Life Changes Family Services
• Life Changes Inc
• Life Changez, Inc
• Life Enhancement Home Care LLC
• Life Structures, Inc.
• Life Structures, Inc.
• Lifepath, PLLC
• Lifespan, Inc.
• Lifespan, Inc.

• Durable Medical Equipment & Medical Supplies in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Durable Medical Equipment & Medical Supplies in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2016; 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.