Organization
LIFE SOURCE MEDICAL, INC.
Active
Parent organization
LIFE SOURCE MEDICAL, INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
LIFE SOURCE MEDICAL, INC.
Authorized official
GINGER P MAXWELL (PRESIDENT)
(336) 316-1166
Entity
Organization
Contact information
Practice address
1439 MAIN STREET, SUITE 1, PRINCETON, WV 24740
(304) 431-3000
(304) 431-3330
Mailing address
1439 MAIN STREET, SUITE 1, PRINCETON, WV 24740
(304) 431-3000
(304) 431-3330
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
12/31/2007
Last updated
12/31/2007
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