# ONE SOURCE MEDICAL GROUP LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** One Source Medical Group LLC
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366653545
- **Authorized official:** DANIEL J ROBICHAUD (CEO)
- **Authorized official phone:** (866) 834-7473

## Contact information

- **Practice address:** 13910 LYNMAR BLVD, TAMPA, FL 33626
- **Practice address phone:** (813) 792-3560
- **Practice address fax:** (877) 490-9111
- **Mailing address:** 13910 LYNMAR BLVD, TAMPA, FL 33626-3123
- **Mailing address phone:** (866) 834-7473
- **Mailing address fax:** (877) 490-9111

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 1313496 | FL | Yes |
| 332BP3500X | Parenteral & Enteral Nutrition Supplies (DME) | — | NULL | — |

## Other

- **Enumeration date:** 05/27/2007
- **Last updated:** 08/24/2022