| NPI | 1952014516 |
|---|---|
| Other Name | SOURCE DIRECT MEDICAL SUPPLY, INC |
| Entity Type | Organization |
| Authorized Contact | CAROLINE JACKSON President 219-472-8091 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies |
| Enumeration Date | 2022-12-28 |
| Last Update Date | 2025-06-02 |