Organization
SOURCE 1
Active
Parent organization
SOURCE 1
Other names
Flatirons Sports medicine or Source 1-DME
Organization subpart
Yes
Provider details
NPI number
Legal business name
SOURCE 1
Authorized official
MR. TRACY JOHN FOX (OWNER)
(303) 324-7674
Entity
Organization
Contact information
Practice address
80 HEALTH PARK DR STE 250, LOUISVILLE, CO 80027-4645
(303) 665-9773
(303) 665-9774
Mailing address
3012 MICA CT, SUPERIOR, CO 80027-4548
(303) 554-6699
(303) 554-6700
Taxonomy
Speciality
Code
Description
License number
State
332BC3200X
Customized Equipment (DME)
Primary
4274647
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1609109776
MAIN BUSINESS LOCATION NPI FOR SOURCE 1
CO
Enumeration date
09/09/2009
Last updated
09/15/2009
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