Source Direct Medical Supply, Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

SOURCE DIRECT MEDICAL SUPPLY, INC

Practice address

509 W 84TH Dr Ste C
Merrillville, IN 46410-5694

Phone

(219) 472-8091

NPI assigned

Dec 28, 2022

Organization subpart

No

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

Authorized official

Name

Mrs. Caroline Jackson

Title

President

Phone

(219) 472-8091

Specialties & licenses 1

Addresses

Other names 1

• Source Direct Medical Supply, Inc Other name

Locations

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

{
    "created_epoch": "1672185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1748822400000",
    "number": "1952014516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "509 W 84TH DR STE C",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464105694",
            "telephone_number": "219-472-8091"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "509 W 84TH DR STE C",
            "city": "MERRILLVILLE",
            "state": "IN",
            "postal_code": "464105694",
            "telephone_number": "219-472-8091"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOURCE DIRECT MEDICAL SUPPLY, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-28",
        "last_updated": "2025-06-02",
        "certification_date": "2025-06-02",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "CAROLINE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "219-472-8091",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Source Direct Medical Supply, Inc",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Durable Medical Equipment & Medical Supplies in Merrillville, IN
• Providers in Merrillville, IN by specialty
• Durable Medical Equipment & Medical Supplies in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2025; 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.