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NPI Code Detail

MEDICARE: MED SOURCES, LTD.

MEDICARE: MED SOURCES, LTD.
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
1207Q00000XFamily Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1528070059
Entity Type Code : Organization
Provider Name (Legal Business Name) : MED SOURCES, LTD.
Provider Business Mailing Address
First Line : PO BOX 30071
Second Line :
City : NEW ORLEANS
State : LA
Zip : 70190-0071
Country : US
Telephone Number : 888-302-1044
Fax Number :
Provider Business Practice Location Address
First Line : 6 SOUTHPARK SHOPPING CTR
Second Line :
City : NASHVILLE
State : AR
Zip : 71852-3307
Country : US
Telephone Number : 870-451-9664
Fax Number : 870-451-9672
Authorized Official
Title or Position : CFO
Name : JAMES D WHITE
Credential :
Telephone Number : 888-302-1044
Provider Enumeration Date : 08/13/2006
Last Update Date : 07/21/2008

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