Organization
LIFE SOURCE MEDICAL SUPPLY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID ROSE (MANAGING DIRECTOR)
(316) 260-9314
Entity
Organization
Contact information
Practice address
1119 W DOUGLAS AVE, WICHITA, KS 67213-4017
(316) 260-9314
(316) 260-9316
Mailing address
1119 W DOUGLAS AVE, WICHITA, KS 67213-4017
(316) 260-9314
(316) 260-9316
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200532650A
—
KS
Enumeration date
11/05/2007
Last updated
06/21/2011
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