CMS-1500 Box 24J / 33a • NPI
1730708017
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
305S00000X
Licensed & Credentialed Point of Service
Box 32 Service Location & ZIP+4
2440 W MISSION LN STE 5, PHOENIX, AZ, 85021-2824
✓ 9-Digit EDI 837 ZIP+4 (85021-2824)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1730708017 (1 SOURCE LABS AND MEDICAL SERVICES LLC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1730708017 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | 1 SOURCE LABS AND MEDICAL SERVICES LLC |
| Plain-English Specialty | Licensed & Credentialed Point of Service NUCC Code: 305S00000X (Point of Service) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 2440 W MISSION LN STE 5, PHOENIX, AZ, 85021-2824 |
| Practice Telephone / Fax | Tel: (623) 261-1716 | Fax: (623) 321-1569 |
| Administrative Mailing Address | 2440 W MISSION LN STE 5, PHOENIX, AZ, 85021-2824 |
| Enumeration & Last Sync | Enumerated: 2020-04-16 | CMS Record Updated: 2020-04-16 |
| Authorized Official | MANUEL SALGADO (CEO) |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (305S00000X)
What Does Taxonomy Code 305S00000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 305S00000X translates to:
"Licensed & Credentialed Point of Service"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (1 SOURCE LABS AND MEDICAL SERVICES LLC)
Typical CPT / Diagnostic Procedures:- Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
- Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
- Preventive Screening, Patient Counseling & Multidisciplinary Referral
- Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
305S00000X — Point of ServicePlain English: Licensed & Credentialed Point of Service | State: N/A | License: Verified | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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