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Organization

MEDSOURCE LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. ERIC ROHDE (OWNER)
(888) 510-5100
Entity
Organization

Contact information

Practice address
3002 GILL STREET, BLOOMINGTON, IL 61704-3438
(888) 510-5100
(888) 510-5200
Mailing address
P.O. BOX 1248, BLOOMINGTON, IL 61702-1248
(888) 510-5100
(888) 510-5200

Taxonomy

Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
203.000461
IL

Other

Enumeration date
11/01/2006
Last updated
08/04/2022
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