Single Source Medical, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

SINGLE SOURCE MEDICAL, LLC

Practice address

2868 Prospect Park Dr
Suite 600
Rancho Cordova, CA 95670-6020

Phone

(916) 631-1236

Fax

(916) 636-9787

NPI assigned

Sep 26, 2009

Last updated

Sep 26, 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. Gregory R Petersen

Title

Managing Member

Phone

(916) 631-1236

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1253923200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1253923200000",
    "number": "1336473164",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2868 PROSPECT PARK DR",
            "address_2": "SUITE 600",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "956706020",
            "telephone_number": "916-631-1236",
            "fax_number": "916-636-9787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2868 PROSPECT PARK DR",
            "address_2": "SUITE 600",
            "city": "RANCHO CORDOVA",
            "state": "CA",
            "postal_code": "956706020",
            "telephone_number": "916-631-1236",
            "fax_number": "916-636-9787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SINGLE SOURCE MEDICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-26",
        "last_updated": "2009-09-26",
        "status": "A",
        "authorized_official_last_name": "PETERSEN",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "916-631-1236",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 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.