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General NPI Number Information
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NPI Number | 1134442361
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Entity Type | Organization
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Legal Business Name | MEDSOURCE LLC
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Dates
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Enumeration Date | 03/02/2010
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Last Update Date | 08/18/2018
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Provider Practice Location Address
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Address Line | 8600 W 95TH ST SUITE 100A
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City | OVERLAND PARK
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State | KS
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Zip | 66212
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Country | US
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Telephone | 913-499-0481
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Fax | 913-499-0482
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Provider Business Mailing Address
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Address Line | PO BOX 1248
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City | BLOOMINGTON
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State | IL
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Zip | 61702-1248
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Country | US
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Telephone | 309-664-7930
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Fax | 309-664-7931
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Authorized Official
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Title or Position | OWNER
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Name | MR. ERIC ROHDE
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Credential |
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Telephone | 309-664-7930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 16-00299
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License Number State | KS
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