Provider Demographics
NPI:1609008085
Name:ONE SOURCE M EDIA
Entity type:Organization
Organization Name:ONE SOURCE M EDIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ELSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMBLEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-268-9368
Mailing Address - Street 1:PO BOX 1129
Mailing Address - Street 2:
Mailing Address - City:COPIAGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11726-0898
Mailing Address - Country:US
Mailing Address - Phone:917-975-7183
Mailing Address - Fax:516-833-5893
Practice Address - Street 1:37 RODNEY LN
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-1651
Practice Address - Country:US
Practice Address - Phone:917-975-7183
Practice Address - Fax:888-268-9368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies