One Source Medical Supply LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

ONE SOURCE MEDICAL SUPPLY LLC

Practice address

1829 Park LN S Ste 8
Jupiter, FL 33458

Phone

(888) 258-7080

Fax

(888) 881-5950

NPI assigned

Jul 1, 2005

Organization subpart

No

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

Authorized official

Name

Ms. Linda Chan

Title

President

Phone

(888) 258-7080

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1120176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536192000000",
    "number": "1699772897",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1829 PARK LN S STE 8",
            "city": "JUPITER",
            "state": "FL",
            "postal_code": "334588086",
            "telephone_number": "888-258-7080",
            "fax_number": "888-881-5950"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1829 PARK LN S STE 8",
            "city": "JUPITER",
            "state": "FL",
            "postal_code": "33458",
            "telephone_number": "888-258-7080",
            "fax_number": "888-881-5950"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ONE SOURCE MEDICAL SUPPLY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-01",
        "last_updated": "2018-09-06",
        "status": "A",
        "authorized_official_last_name": "CHAN",
        "authorized_official_first_name": "LINDA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "888-258-7080",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "FL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "010213900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "R9667",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2018; 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.