Source 1

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

License

4274647 Issued in CO

Legal business name

SOURCE 1

Doing business as

Flatirons Sports medicine or Source 1-DME

Practice address

80 Health Park Dr Ste 250
Louisville, CO 80027-4645

Phone

(303) 665-9773

Fax

(303) 665-9774

NPI assigned

Sep 9, 2009

Last updated

Sep 15, 2009By the provider in NPPES

Organization subpart

Yes

Parent organization

SOURCE 1As reported in NPPES

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

Authorized official

Name

Mr. Tracy John Fox

Title

Owner

Phone

(303) 324-7674

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Flatirons Sports medicine or Source 1-DME Doing business as

Tax ID family

Source 14 organizations share this tax ID, including this one

Part of

Source 1

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

• Source 1

  dba Source 1 - DME

  • Customized Equipment (DME)
  • Loveland, CO
  • NPI 1063749265
  NPD tax ID
• Source 1

  dba flatirons sports medicine or Source 1- DME

  • Customized Equipment (DME)
  • Superior, CO
  • NPI 1609109776
  NPD tax ID
• Source 1

  dba Flatirons sports medicine or Source 1-DME

  • Customized Equipment (DME)
  • Wheat Ridge, CO
  • NPI 1821321860
  NPD tax ID

Locations

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

{
    "created_epoch": "1252454400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252972800000",
    "number": "1578896502",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3012 MICA CT",
            "city": "SUPERIOR",
            "state": "CO",
            "postal_code": "800274548",
            "telephone_number": "303-554-6699",
            "fax_number": "303-554-6700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "80 HEALTH PARK DR STE 250",
            "city": "LOUISVILLE",
            "state": "CO",
            "postal_code": "800274645",
            "telephone_number": "303-665-9773",
            "fax_number": "303-665-9774"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOURCE 1",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SOURCE 1",
        "enumeration_date": "2009-09-09",
        "last_updated": "2009-09-15",
        "status": "A",
        "authorized_official_last_name": "FOX",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "303-324-7674",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "CO",
            "license": "4274647",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAIN BUSINESS LOCATION NPI FOR SOURCE 1",
            "identifier": "1609109776",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Flatirons Sports medicine or Source 1-DME",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Customized Equipment (DME) in Louisville, CO
• Providers in Louisville, CO by specialty
• Customized Equipment (DME) in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 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.