| Organization Name: | MED SOURCE SUPPLY AND SERVICE, LLC |
| NPI Number: | 1366693806 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RO B FERNANDEZ (MANAGER) |
| Mailing Address: | 3116 Wilson Rd Suite B Centerburg |
| State: | OH US |
| Postal Code: | 430119467 |
| Phone Number: | 8776721026 |
| Fax Number: | 8005317906 |
| NPI Enumeration Date: | 10/02/2008 |
| NPI Last Update Date: | 05/04/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332B00000X |
| License Number: | 90022024 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OH |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient |