Healthsource, Inc.

Primary specialty

Parenteral & Enteral Nutrition Supplies (DME)Taxonomy code 332BP3500X

License

0000000879 Issued in TN

Legal business name

HEALTHSOURCE, INC.

Practice address

5211 Highway 153
Suite K
Hixson, TN 37343-4956

Phone

(423) 648-2095

NPI assigned

Nov 14, 2006

Organization subpart

No

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

Authorized official

Name

Rebecca Fortner

Title

Ceo

Phone

(423) 648-2095

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1780756148",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5211 HIGHWAY 153",
            "address_2": "SUITE K",
            "city": "HIXSON",
            "state": "TN",
            "postal_code": "373434956",
            "telephone_number": "423-648-2095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5211 HIGHWAY 153",
            "address_2": "SUITE K",
            "city": "HIXSON",
            "state": "TN",
            "postal_code": "373434956",
            "telephone_number": "423-648-2095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HEALTHSOURCE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FORTNER",
        "authorized_official_first_name": "REBECCA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "423-648-2095"
    },
    "taxonomies": [
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "TN",
            "license": "0000000879",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1455029",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Parenteral & Enteral Nutrition Supplies (DME) in Hixson, TN
• Providers in Hixson, TN by specialty
• Parenteral & Enteral Nutrition Supplies (DME) in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.