Organization
SOURCE ONE MOBILITY, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RONNIE C KLINE (PRESIDENT)
(757) 463-5590
Entity
Organization
Contact information
Practice address
629 PHOENIX DR, SUITE 115, VIRGINIA BEACH, VA 23452-7392
(757) 463-5590
(757) 463-5592
Mailing address
629 PHOENIX DR, SUITE 115, VIRGINIA BEACH, VA 23452-7392
(757) 463-5590
(757) 463-5592
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
838765200
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9108432
—
VA
Enumeration date
05/31/2006
Last updated
12/08/2008
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