MEDICARE: MEDISOURCE CORP

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
1	332B00000X	Durable Medical Equipment & Medical Supplies	1065190001	FL

General Provider Information

NPI Number	:	1922032275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDISOURCE CORP

Provider Business Mailing Address
First Line	:	7040 W PALMETTO PARK RD
Second Line	:	#4-575
City	:	BOCA RATON
State	:	FL
Zip	:	33433-3407
Country	:	US
Telephone Number	:	561-361-9604
Fax Number	:	561-394-5186

Provider Business Practice Location Address
First Line	:	7025 BERACASA WAY
Second Line	:	SUITE 102B
City	:	BOCA RATON
State	:	FL
Zip	:	33433-3443
Country	:	US
Telephone Number	:	561-361-9604
Fax Number	:	561-394-5186

Authorized Official
Title or Position	:	VP
Name	:	MRS. ANN ARBEITMAN
Credential	:	VP
Telephone Number	:	561-361-9604

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	08/22/2020

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Directions to “MEDISOURCE CORP ” Practice Location

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