MEDICARE: SOURCE UNLIMITED 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	251E00000X	Home Health Agency		OK

General Provider Information

NPI Number	:	1194858290
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOURCE UNLIMITED INC

Provider Business Mailing Address
First Line	:	4801 N CLASSEN BLVD STE 239
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-4622
Country	:	US
Telephone Number	:	405-840-5558
Fax Number	:	405-840-9194

Provider Business Practice Location Address
First Line	:	4801 N CLASSEN BLVD STE 239
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73118-4622
Country	:	US
Telephone Number	:	405-840-5558
Fax Number	:	405-840-9194

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MARVETTA KAY VAUGHNS
Credential	:
Telephone Number	:	405-840-5558

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	02/13/2008

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