Med Source Supply and Service, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

90022024 Issued in OH

Legal business name

MED SOURCE SUPPLY AND SERVICE, LLC

Practice address

3116 Wilson Rd
Suite B
Centerburg, OH 43011-9467

Phone

(877) 672-1026

Fax

(800) 531-7906

NPI assigned

Oct 2, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ro B Fernandez

Title

Manager

Phone

(614) 572-9748

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1222905600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1336089600000",
    "number": "1366693806",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3116 WILSON RD",
            "address_2": "SUITE B",
            "city": "CENTERBURG",
            "state": "OH",
            "postal_code": "430119467",
            "telephone_number": "877-672-1026",
            "fax_number": "800-531-7906"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3116 WILSON RD",
            "address_2": "SUITE B",
            "city": "CENTERBURG",
            "state": "OH",
            "postal_code": "430119467",
            "telephone_number": "877-672-1026",
            "fax_number": "800-531-7906"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MED SOURCE SUPPLY AND SERVICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-02",
        "last_updated": "2012-05-04",
        "status": "A",
        "authorized_official_last_name": "FERNANDEZ",
        "authorized_official_first_name": "RO",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "614-572-9748"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "OH",
            "license": "90022024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in Centerburg, OH
• Providers in Centerburg, OH by specialty
• Durable Medical Equipment & Medical Supplies in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.