Medisource Management, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

MEDISOURCE MANAGEMENT, LLC

Practice address

145 Dwight Park Cir
Syracuse, NY 13209-1005

Phone

(315) 457-8337

NPI assigned

Feb 14, 2008

Organization subpart

No

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

Authorized official

Name

Mr. Adrew Jay Henty Sr.

Title

Managing Partner

Phone

(315) 457-8337

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Locations

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

{
    "created_epoch": "1202947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285027200000",
    "number": "1982872669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "145 DWIGHT PARK CIR",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132091005",
            "telephone_number": "315-457-8337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "145 DWIGHT PARK CIR",
            "city": "SYRACUSE",
            "state": "NY",
            "postal_code": "132091005",
            "telephone_number": "315-457-8337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDISOURCE MANAGEMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-02-14",
        "last_updated": "2010-09-21",
        "status": "A",
        "authorized_official_last_name": "HENTY",
        "authorized_official_first_name": "ADREW",
        "authorized_official_middle_name": "JAY",
        "authorized_official_title_or_position": "MANAGING PARTNER",
        "authorized_official_telephone_number": "315-457-8337",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Sr."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joseph James Medicis, PHARM.D.
• Karen L Medin, D.O.
• Mariangeles Medina Perez, M.D.
• Kaitlin Medina
• Medipro Suppliers Inc.
• Medix Supply Inc.
• Ioana Medrea, M.D.
• Medspa Solutions, LLC
• Hollie Meehan
• James L Megna, M.D.

• Durable Medical Equipment & Medical Supplies in Syracuse, NY
• Providers in Syracuse, NY by specialty
• Durable Medical Equipment & Medical Supplies in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.