Organization
MEDSOURCE INC.
Active
Other names
Medsource
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ROBERT G WILSON RN (OWNER)
(803) 926-2919
Entity
Organization
Contact information
Practice address
1311 AUGUSTA RD, WEST COLUMBIA, SC 29169-6320
(803) 926-2919
Mailing address
1311 AUGUSTA RD, WEST COLUMBIA, SC 29169-6320
(803) 926-2919
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
DME993
—
SC
Enumeration date
10/18/2005
Last updated
04/17/2008
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