Source 1

NPI #1063749265 in Loveland, Colorado

Provider Information

NPI Number: 1063749265
Entity Type: Organization
Organization Name: Source 1
Primary Specialty: Durable Medical Equipment & Medical Supplies - Customized Equipment
Enumeration Date: Nov 9, 2009
Last Updated: Nov 9, 2009

Practice Location

Address: 1615 FOXTRAIL DR STE 190
City: Loveland
State: Colorado
ZIP Code: 80538-9087
Phone: (303) 952-0396

Authorized Official

Name: MR. TRACY JOHN FOX
Title: BUSINESS OWNER
Phone: (303) 952-0396

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Durable Medical Equipment & Medical Supplies - Customized Equipment — Customized Equipment	332BC3200X	Primary

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