Organization
PAYLESS MEDICAL SUPPLIES, LLC
Active
Other names
One Source Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JON ROBICHAUD (MANAGING MEMBER)
(506) 871-9455
Entity
Organization
Contact information
Practice address
108 N FAYETTEVILLE ST STE J, LIBERTY, NC 27298-3203
(866) 533-0772
(866) 629-5786
Mailing address
13910 LYNMAR BLVD, TAMPA, FL 33626-3123
(866) 533-0772
(866) 629-5786
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
332BP3500X
Parenteral & Enteral Nutrition Supplies (DME)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7504290001
MEDICARE PTAN
NC
Enumeration date
07/13/2015
Last updated
08/24/2022
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