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General NPI Number Information
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NPI Number | 1801300058
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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 | 11/27/2017
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Last Update Date | 09/12/2025
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Provider Practice Location Address
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Address Line | 75 PRINTERS PKWY STE 120
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City | COLORADO SPRINGS
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State | CO
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Zip | 80910-3109
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Country | US
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Telephone | 719-375-3299
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Fax |
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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 | 888-510-5100
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Fax | 888-510-5200
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Authorized Official
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Title or Position | OWNER/MANAGING PARTNER
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Name | 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 | 20176001145
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License Number State | CO
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