Medisource, Inc

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

MEDISOURCE, INC

Practice address

555 N El Camino Real
A376
San Clemente, CA 92672-6740

Phone

(949) 412-2639

Fax

(888) 500-0171

NPI assigned

Jan 16, 2013

Organization subpart

No

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

Authorized official

Name

Mr. Jerry R Steele

Title

Owner

Phone

(949) 412-2639

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1358294400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1358294400000",
    "number": "1689912263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "555 N EL CAMINO REAL",
            "address_2": "A376",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926726740",
            "telephone_number": "949-412-2639",
            "fax_number": "888-500-0171"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "555 N EL CAMINO REAL",
            "address_2": "A376",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926726740",
            "telephone_number": "949-412-2639",
            "fax_number": "888-500-0171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDISOURCE, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-16",
        "last_updated": "2013-01-16",
        "status": "A",
        "authorized_official_last_name": "STEELE",
        "authorized_official_first_name": "JERRY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "949-412-2639",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Durable Medical Equipment & Medical Supplies in San Clemente, CA
• Providers in San Clemente, CA by specialty
• Durable Medical Equipment & Medical Supplies in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2013; 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.