Source One Medical Inc

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

License

103616 Issued in CA

Legal business name

SOURCE ONE MEDICAL INC

Practice address

16 Technology Dr
Suite 165
Irvine, CA 92618-2328

Phone

(888) 447-9056

Fax

(949) 387-6371

NPI assigned

Jun 20, 2005

Organization subpart

No

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

Authorized official

Name

Dennis Kline

Title

President/Ceo

Phone

(888) 447-9056

Specialties & licenses 1

Addresses

Other names 1

• Source One Medical Inc Former legal business name

Locations

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

{
    "created_epoch": "1119225600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336953600000",
    "number": "1619972239",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16 TECHNOLOGY DR",
            "address_2": "SUITE165",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926182328",
            "telephone_number": "888-447-9056",
            "fax_number": "949-387-6371"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 TECHNOLOGY DR",
            "address_2": "SUITE 165",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926182328",
            "telephone_number": "888-447-9056",
            "fax_number": "949-387-6371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOURCE ONE MEDICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-20",
        "last_updated": "2012-05-14",
        "status": "A",
        "authorized_official_last_name": "KLINE",
        "authorized_official_first_name": "DENNIS",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "888-447-9056"
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "CA",
            "license": "103616",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Source One Medical Inc",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

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• Customized Equipment (DME) in Irvine, CA
• Providers in Irvine, CA by specialty
• Customized Equipment (DME) in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2012; 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.