Organization
ONE SOURCE MEDICAL GROUP LLC
Active
Other names
One Source Medical Group LLC
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL J ROBICHAUD (CEO)
(866) 834-7473
Entity
Organization
Contact information
Practice address
13910 LYNMAR BLVD, TAMPA, FL 33626
(813) 792-3560
(877) 490-9111
Mailing address
13910 LYNMAR BLVD, TAMPA, FL 33626-3123
(866) 834-7473
(877) 490-9111
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
1313496
FL
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
032072200
—
FL
01
—
5703548
NCPDP PROVIDER IDENTIFICATION NUMBER
—
Enumeration date
05/27/2007
Last updated
08/24/2022
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