Source Surgical Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

SOURCE SURGICAL INC

Practice address

644 Cesery Blvd Ste 315
Jacksonville, FL 32211-7165

Phone

(904) 234-3980

Fax

(904) 374-5737

NPI assigned

Sep 24, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Joel N/a CregutNPI 1639668379

Title

President

Phone

(904) 234-3980

Specialties & licenses 1

Addresses

Locations

Practitioners 1

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

• Joel None Cregut

  • Durable Medical Equipment & Medical Supplies
  • Jacksonville, FL
  • NPI 1639668379
  NPD Authorized official

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

{
    "created_epoch": "1379980800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1579651200000",
    "number": "1538595301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "644 CESERY BLVD STE 315",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322117165",
            "telephone_number": "904-234-3980",
            "fax_number": "904-374-5737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "644 CESERY BLVD STE 315",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322117165",
            "telephone_number": "904-234-3980",
            "fax_number": "904-374-5737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOURCE SURGICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-24",
        "last_updated": "2020-01-22",
        "certification_date": "2020-01-22",
        "status": "A",
        "authorized_official_last_name": "CREGUT",
        "authorized_official_first_name": "JOEL",
        "authorized_official_middle_name": "N/A",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-234-3980",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• Durable Medical Equipment & Medical Supplies in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2020; 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.