=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982690798
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HEALTHSOURCE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2005
-----------------------------------------------------
Last Update Date | 02/17/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2610 LAMAR AVE SUITE P
-----------------------------------------------------
City | PARIS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75460-4847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-785-1800
-----------------------------------------------------
Fax | 903-785-1806
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2610 LAMAR AVE SUITE P
-----------------------------------------------------
City | PARIS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75460-4847
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 903-785-1800
-----------------------------------------------------
Fax | 903-785-1806
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | PAUL VINSON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 903-785-1800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 0074380
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------