Source 1

NPI #1609109776 in Superior, Colorado

Provider Information

NPI Number: 1609109776
Entity Type: Organization
Organization Name: Source 1
Primary Specialty: Durable Medical Equipment & Medical Supplies - Customized Equipment
Enumeration Date: Sep 8, 2009
Last Updated: Sep 14, 2009

Practice Location

Address: 3012 MICA CT
City: Superior
State: Colorado
ZIP Code: 80027-4548
Phone: (303) 554-6699

Authorized Official

Name: MR. TRACY JOHN FOX
Title: OWNER
Phone: (303) 324-7674

Specialties & Taxonomy Codes

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

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