LIFE SOURCE MEDICAL, INC. (NPI# 1326223082) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1326223082 |
| Entity Type | Organization |
| Organization Name | LIFE SOURCE MEDICAL, INC. |
| Practice Address |
1439 Main Street Suite 1 Princeton WV 24740 |
| Practice Telephone | 3044313000 |
| Practice Fax Number | 3044313330 |
| Mailing Telephone | 3044313000 |
| Mailing Fax Number | 3044313330 |
| Enumeration Date | 2007-12-31 |
| Last Update Date | 2007-12-31 |
| Authorized Official Name | GINGER P MAXWELL (PRESIDENT) |
| Authorized Official Telephone | 3363161166 |
| Is Organization Subpart | Y |
| Parent Organization Name | LIFE SOURCE MEDICAL, INC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083804785 | Life Source Medical, Inc. | Durable Medical Equipment & Medical Supplies | 377 S Swing Rd, Greensboro, NC 27409-2009 | 2007-07-28 |
| Street Address |
1439 MAIN STREET SUITE 1 |
| City | PRINCETON |
| State | WV |
| Zip Code | 24740 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427658632 | New Beginnings Therapy Services, LLC | Community/Behavioral Health | 616 Harrison Street, Princeton, WV 24740 | 2020-10-27 |
| 1215536222 | Right At Home | Home Health | 313 Locus St, Princeton, WV 24740 | 2020-10-21 |
| 1881208098 | Robin Lane | Technician | 174 Tea Kettle Road, Princeton, WV 24740 | 2020-09-04 |
| 1134739824 | Nona Arthur | Technician | 708 Bluefiled Ave, Princeton, WV 24740 | 2020-08-06 |
| 1851909014 | Tina B Altizer | Speech-Language Pathologist | 120 12th Street, Princeton, WV 24740 | 2020-07-14 |
| 1245712504 | Tracy Jean Mitchell | Speech-Language Pathologist | 1200 Mercer St, Princeton, WV 24740 | 2018-09-04 |
| 1700305240 | Tina Six | Registered Nurse | 1403 Honaker Avenue, Princeton, WV 24740 | 2017-09-15 |
| 1013449172 | Karin Cappa | Pharmacist | 669 Cornfield Rd, Princeton, WV 24740 | 2017-03-29 |
| 1942661723 | Virginia Chryssikos | Social Worker | 3016 E Cumberland Road, Bluestone Family Practice, Bluefield, WV 24740 | 2016-03-08 |
| 1477939460 | Kathy Diane Wyrick | Counselor | 220 South Walker Street, Princeton, WV 24740 | 2015-08-03 |
| Find all providers in zip 24740 | ||||
| Taxonomy Code | 332B00000X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient’s use in the home and that are usable for an extended period of time. |
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| 1871157644 | Evercare Pharmacy, LLC | Durable Medical Equipment & Medical Supplies | 21748 Us Highway 65, Princeton, MO 64673-7865 | 2019-04-27 |
| 1033643010 | Deaconess Hospital, Inc | Durable Medical Equipment & Medical Supplies | 1416 W. Broadway St, Princeton, IN 47670 | 2017-04-17 |
| 1487191508 | Nephatari Ford | Durable Medical Equipment & Medical Supplies | 24801 Sw 130th Ave Apt 205, Princeton, FL 33032-4095 | 2017-01-26 |
| 1982064374 | Wal-mart Stores Texas LLC | Durable Medical Equipment & Medical Supplies | 701 W Princeton Dr, Princeton, TX 75407-9002 | 2016-02-29 |
| 1306261011 | Massey's Medical Supplies | Durable Medical Equipment & Medical Supplies | 300 W Princeton Dr Ste 2, Princeton, TX 75407-9709 | 2014-03-04 |
| 1942621156 | A & K Medical Supplies | Durable Medical Equipment & Medical Supplies | 300 W Princeton Dr, Suite 2, Princeton, TX 75407-9710 | 2013-12-16 |
| 1225379308 | Costa Medical | Durable Medical Equipment & Medical Supplies | 32 Nassau St, Suite 300, Princeton, NJ 08542-4503 | 2013-03-14 |
| 1649551557 | Princeton Mobility and Medical Products | Durable Medical Equipment & Medical Supplies | 116 S Rum River Dr, Suite 6b, Princeton, MN 55371-4532 | 2011-09-06 |
| 1346481546 | Walgreen Co | Durable Medical Equipment & Medical Supplies | 1915 W Broadway St, Princeton, IN 47670-1095 | 2009-03-18 |
| Find all providers in PRINCETON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.