NPIMap

Organization Active NPI

Source 1

  • Customized Equipment (DME)
  • Superior, CO
National Provider Identifier
1609109776
Registry record updated Sep 14, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Customized Equipment (DME)Taxonomy code 332BC3200X
License
4274647 Issued in CO
Legal business name
SOURCE 1
Practice address
3012 Mica CT
Superior, CO 80027-4548
Phone
(303) 554-6699
Fax
(303) 554-6700
NPI assigned
Sep 8, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 14, 2009

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

Specialty (taxonomy)CodeLicenseStatePrimary
Customized Equipment (DME) 332BC3200X 4274647 CO Primary

Addresses

Primary practice location

3012 Mica CT
Superior, CO 80027-4548

Mailing address

3012 Mica CT
Superior, CO 80027-4548
Phone (303) 554-6699

Other names 1

  • flatirons sports medicine or Source 1- DME Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Source 14 organizations share this tax ID, including this one

Other organizations with this tax ID 3

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

NPI Registry JSON

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

{
    "created_epoch": "1252368000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252886400000",
    "number": "1609109776",
    "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": "3012 MICA CT",
            "city": "SUPERIOR",
            "state": "CO",
            "postal_code": "800274548",
            "telephone_number": "303-554-6699",
            "fax_number": "303-554-6700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOURCE 1",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-08",
        "last_updated": "2009-09-14",
        "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "flatirons sports medicine or Source 1- DME",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Superior, CO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 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.