NPIMap

Organization Active NPI

Source One Healthcare a Division of Phillips Pharmacies

  • Health Maintenance Organization
  • Mauston, WI
National Provider Identifier
1205997517
Registry record updated Nov 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Maintenance OrganizationTaxonomy code 302R00000X
Legal business name
SOURCE ONE HEALTHCARE A DIVISION OF PHILLIPS PHARMACIES
Practice address
123 E State St
Mauston, WI 53948-1344
Phone
(800) 779-1276
Fax
(608) 847-5739
NPI assigned
Dec 12, 2006
Last updated
Nov 13, 2007By the provider in NPPES
Organization subpart
Yes
Parent organization
PHILLIPS DRUG STORE INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 13, 2007

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

Authorized official

Name
Wayne MacardyNPI 1649440124
Title
President
Phone
(800) 779-1276

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X Primary

Addresses

Primary practice location

123 E State St
Mauston, WI 53948-1344

Mailing address

123 E State St
P.O. Box 218
Mauston, WI 53948-1344
Phone (800) 779-1276

Other names 1

  • Sourceone Healthcare Other name

National Provider Directory

National Provider Directory
Part of
Phillips Drug Store Inc

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1165881600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194912000000",
    "number": "1205997517",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "123 E STATE ST",
            "address_2": "P.O. BOX 218",
            "city": "MAUSTON",
            "state": "WI",
            "postal_code": "539481344",
            "telephone_number": "800-779-1276",
            "fax_number": "608-847-5739"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "123 E STATE ST",
            "city": "MAUSTON",
            "state": "WI",
            "postal_code": "539481344",
            "telephone_number": "800-779-1276",
            "fax_number": "608-847-5739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOURCE ONE HEALTHCARE A DIVISION OF PHILLIPS PHARMACIES",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PHILLIPS DRUG STORE INC.",
        "enumeration_date": "2006-12-12",
        "last_updated": "2007-11-13",
        "status": "A",
        "authorized_official_last_name": "MACARDY",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "800-779-1276"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Sourceone Healthcare",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Mauston, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2007; 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.