Organization
MEDSOURCE MIDWEST L.L.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID CROSSET WAGENSELLER (PRESIDENT/OWNER)
(614) 315-5115
Entity
Organization
Contact information
Practice address
101 N SOUTH ST, WILMINGTON, OH 45177-1646
(614) 315-5115
Mailing address
101 N SOUTH ST, WILMINGTON, OH 45177-1646
(614) 315-5115
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
332B00000X
OH
Other
Enumeration date
10/12/2007
Last updated
10/12/2007
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