# MEDSOURCE MD, INC.

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

## Provider details

- **NPI number:** 1922263649
- **Authorized official:** MR. TERRY L MAYNARD SR. (VICE PRESIDENT)
- **Authorized official phone:** (216) 289-9112

## Contact information

- **Practice address:** 27801 EUCLID AVE, SUITE 550, EUCLID, OH 44132-3549
- **Practice address phone:** (216) 289-9112
- **Practice address fax:** (216) 731-8545
- **Mailing address:** 27801 EUCLID AVE, SUITE 550, EUCLID, OH 44132-3549
- **Mailing address phone:** (216) 289-9112
- **Mailing address fax:** (216) 731-8545

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251E00000X | Home Health Agency | 35-055749 | OH | Yes |

## Other

- **Enumeration date:** 07/22/2008
- **Last updated:** 12/10/2008