Organization
SOURCE DIRECT MEDICAL SUPPLY, INC
Active
Other names
Source Direct Medical Supply, Inc
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. CAROLINE JACKSON (PRESIDENT)
(219) 472-8091
Entity
Organization
Contact information
Practice address
509 W 84TH DR STE C, MERRILLVILLE, IN 46410-5694
(219) 472-8091
Mailing address
509 W 84TH DR STE C, MERRILLVILLE, IN 46410-5694
(219) 472-8091
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
12/28/2022
Last updated
06/02/2025
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