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General NPI Number Information
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NPI Number | 1922032275
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Entity Type | Organization
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Legal Business Name | MEDISOURCE CORP
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 7025 BERACASA WAY SUITE 102B
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City | BOCA RATON
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State | FL
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Zip | 33433-3443
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Country | US
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Telephone | 561-361-9604
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Fax | 561-394-5186
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Provider Business Mailing Address
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Address Line | 7040 W PALMETTO PARK RD #4-575
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City | BOCA RATON
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State | FL
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Zip | 33433-3407
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Country | US
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Telephone | 561-361-9604
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Fax | 561-394-5186
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Authorized Official
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Title or Position | VP
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Name | MRS. ANN ARBEITMAN
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Credential | VP
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Telephone | 561-361-9604
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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 | 1065190001
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License Number State | FL
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