Source One Medical Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

SOURCE ONE MEDICAL INC

Practice address

2121 New Market Pkwy SE
Suite 108
Marietta, GA 30067-9315

Phone

(888) 447-9056

Fax

(800) 588-1253

NPI assigned

Jun 30, 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 Doing business as

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

{
    "created_epoch": "1120089600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1306454400000",
    "number": "1750388252",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "38 TESLA",
            "address_2": "SUITE 150",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926184670",
            "telephone_number": "888-447-9056",
            "fax_number": "800-588-1253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 NEW MARKET PKWY SE",
            "address_2": "SUITE 108",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300679315",
            "telephone_number": "888-447-9056",
            "fax_number": "800-588-1253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOURCE ONE MEDICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-30",
        "last_updated": "2011-05-27",
        "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": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Source One Medical Inc",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Durable Medical Equipment & Medical Supplies in Marietta, GA
• Providers in Marietta, GA by specialty
• Durable Medical Equipment & Medical Supplies in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2011; 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.