Source One Mobility, Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

838765200 Issued in VA

Legal business name

SOURCE ONE MOBILITY, INC

Practice address

629 Phoenix Dr
Suite 115
Virginia Beach, VA 23452-7392

Phone

(757) 463-5590

Fax

(757) 463-5592

NPI assigned

May 31, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Ronnie C Kline

Title

President

Phone

(757) 463-5590

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1228694400000",
    "number": "1437196367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "629 PHOENIX DR",
            "address_2": "SUITE 115",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234527392",
            "telephone_number": "757-463-5590",
            "fax_number": "757-463-5592"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "629 PHOENIX DR",
            "address_2": "SUITE 115",
            "city": "VIRGINIA BEACH",
            "state": "VA",
            "postal_code": "234527392",
            "telephone_number": "757-463-5590",
            "fax_number": "757-463-5592"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOURCE ONE MOBILITY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-31",
        "last_updated": "2008-12-08",
        "status": "A",
        "authorized_official_last_name": "KLINE",
        "authorized_official_first_name": "RONNIE",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "757-463-5590",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "VA",
            "license": "838765200",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9108432",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Virginia Beach, VA
• Providers in Virginia Beach, VA by specialty
• Durable Medical Equipment & Medical Supplies in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2008; 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.