# MEDSOURCE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669795415
- **Authorized official:** MR. ERIC ROHDE (OWNER)
- **Authorized official phone:** (309) 664-7930

## Contact information

- **Practice address:** 25835 NARBONNE AVE, SUITE 280D, LOMITA, CA 90717-3074
- **Practice address phone:** (888) 510-5100
- **Mailing address:** PO BOX 1248, BLOOMINGTON, IL 61702-1248
- **Mailing address phone:** (309) 664-7930
- **Mailing address fax:** (309) 664-7931

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332B00000X | Durable Medical Equipment & Medical Supplies | 203.000461 | IL | Yes |

## Other

- **Enumeration date:** 03/09/2010
- **Last updated:** 06/27/2012