Medsource LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

203.000461 Issued in IL

Legal business name

MEDSOURCE LLC

Practice address

2301 W 1St St
Ste 5
Ankeny, IA 50023-2470

Phone

(515) 965-6967

Fax

(515) 965-6973

NPI assigned

Aug 7, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Eric Rohde

Title

Owner

Phone

(309) 664-7930

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1218067200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1340150400000",
    "number": "1922264159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1248",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617021248",
            "telephone_number": "309-664-7930",
            "fax_number": "309-664-7931"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2301 W 1ST ST",
            "address_2": "STE 5",
            "city": "ANKENY",
            "state": "IA",
            "postal_code": "500232470",
            "telephone_number": "515-965-6967",
            "fax_number": "515-965-6973"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDSOURCE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-07",
        "last_updated": "2012-06-20",
        "status": "A",
        "authorized_official_last_name": "ROHDE",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "309-664-7930",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "IL",
            "license": "203.000461",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0598110",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 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.