Life Source Medical, Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

LIFE SOURCE MEDICAL, INC.

Practice address

1439 Main Street
Suite 1
Princeton, WV 24740

Phone

(304) 431-3000

Fax

(304) 431-3330

NPI assigned

Dec 31, 2007

Last updated

Dec 31, 2007By the provider in NPPES

Organization subpart

Yes

Parent organization

LIFE SOURCE MEDICAL, INC.As reported in NPPES

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

Authorized official

Name

Ginger P Maxwell

Title

President

Phone

(336) 316-1166

Specialties & licenses 1

Addresses

Part of

Life Source Medical Inc

Locations

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.

• 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": "1199059200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199059200000",
    "number": "1326223082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1439 MAIN STREET",
            "address_2": "SUITE 1",
            "city": "PRINCETON",
            "state": "WV",
            "postal_code": "24740",
            "telephone_number": "304-431-3000",
            "fax_number": "304-431-3330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1439 MAIN STREET",
            "address_2": "SUITE 1",
            "city": "PRINCETON",
            "state": "WV",
            "postal_code": "24740",
            "telephone_number": "304-431-3000",
            "fax_number": "304-431-3330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE SOURCE MEDICAL, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "LIFE SOURCE MEDICAL, INC.",
        "enumeration_date": "2007-12-31",
        "last_updated": "2007-12-31",
        "status": "A",
        "authorized_official_last_name": "MAXWELL",
        "authorized_official_first_name": "GINGER",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "336-316-1166"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Desirae Lewis
• Kimberly Lewis
• Mary E. Lewis, FNP-BC
• Michael Edwin Lewis
• Natajha Lewis
• Destiny Dawn Lilly
• Jessica Lilly
• Kayla M Lilly, RBA
• Melissa Dawn Lilly, PA-C
• Pamela J Lilly

• Durable Medical Equipment & Medical Supplies in Princeton, WV
• Providers in Princeton, WV by specialty
• Durable Medical Equipment & Medical Supplies in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 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.