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Organization

SOURCE ONE MOBILITY LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. ROBERT GALLUP (PRESIDENT)
(801) 281-4500
Entity
Organization

Contact information

Practice address
4455 S 700 E, SUITE 200, SALT LAKE CITY, UT 84107-3153
(801) 281-4500
Mailing address
4455 S 700 E, SUITE 200, SALT LAKE CITY, UT 84107-3153
(801) 281-4500

Taxonomy

Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
5596831-1714
UT

Other

Enumeration date
05/21/2007
Last updated
08/22/2020
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