MEDICARE: CARE 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	332BX2000X	Oxygen Equipment & Supplies (DME)		MI

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	:	1780782607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARE SOURCE, INC

Provider Business Mailing Address
First Line	:	2605 S CLEVELAND AVE
Second Line	:
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-3001
Country	:	US
Telephone Number	:	269-429-5900
Fax Number	:	269-429-0092

Provider Business Practice Location Address
First Line	:	2605 S CLEVELAND AVE
Second Line	:
City	:	SAINT JOSEPH
State	:	MI
Zip	:	49085-3001
Country	:	US
Telephone Number	:	269-429-5900
Fax Number	:	269-429-0092

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MARK A PIERSMA
Credential	:
Telephone Number	:	616-957-3957

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	07/21/2022

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Directions to “CARE SOURCE, INC ” Practice Location

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