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Organization

HEALTHSOURCE, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
REBECCA FORTNER (CEO)
(423) 648-2095
Entity
Organization

Contact information

Practice address
5211 HIGHWAY 153, SUITE K, HIXSON, TN 37343-4956
(423) 648-2095
Mailing address
5211 HIGHWAY 153, SUITE K, HIXSON, TN 37343-4956
(423) 648-2095

Taxonomy

Speciality
Code
Description
License number
State
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
Primary
0000000879
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1455029
TN
Enumeration date
11/14/2006
Last updated
08/22/2020
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