Provider Demographics
NPI:1447486519
Name:ONE SOURCE DME, LLC
Entity type:Organization
Organization Name:ONE SOURCE DME, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:SLATTERY
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:513-325-9304
Mailing Address - Street 1:3080 N CIVIC CENTER PLZ
Mailing Address - Street 2:SUITE #6
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-6921
Mailing Address - Country:US
Mailing Address - Phone:480-375-1161
Mailing Address - Fax:
Practice Address - Street 1:3080 N CIVIC CENTER PLZ
Practice Address - Street 2:SUITE #6
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6921
Practice Address - Country:US
Practice Address - Phone:480-375-1161
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-03
Last Update Date:2009-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies