MEDICARE: ONE SOURCE INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies		MS
2	335E00000X	Prosthetic/Orthotic Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1073511812
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ONE SOURCE INC.

Provider Business Mailing Address
First Line	:	3004 BIENVILLE BLVD
Second Line	:	SUITE 1
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-4370
Country	:	US
Telephone Number	:	228-875-3828
Fax Number	:

Provider Business Practice Location Address
First Line	:	3004 BIENVILLE BLVD
Second Line	:	SUITE 1
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-4370
Country	:	US
Telephone Number	:	228-875-3828
Fax Number	:

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. WILLIAM KEITH WADE
Credential	:
Telephone Number	:	228-875-3828

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	08/17/2020

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Directions to “ONE SOURCE INC. ” Practice Location

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