Organization
MEDSOURCE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ERIC ROHDE (OWNER)
(309) 664-7930
Entity
Organization
Contact information
Practice address
8600 W 95TH ST, SUITE 100A, OVERLAND PARK, KS 66212
(913) 499-0481
(913) 499-0482
Mailing address
PO BOX 1248, BLOOMINGTON, IL 61702-1248
(309) 664-7930
(309) 664-7931
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
16-00299
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16-00391
LICENSE
KS
Enumeration date
03/02/2010
Last updated
08/18/2018
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