Provider Demographics
NPI:1194897553
Name:MEDSOURCE, LLC
Entity type:Organization
Organization Name:MEDSOURCE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLIENT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-440-1909
Mailing Address - Street 1:33 N GARDEN AVE STE 800
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-6614
Mailing Address - Country:US
Mailing Address - Phone:800-440-1909
Mailing Address - Fax:866-206-2900
Practice Address - Street 1:33 N GARDEN AVE STE 800
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-6614
Practice Address - Country:US
Practice Address - Phone:800-440-1909
Practice Address - Fax:866-206-2900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1980251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care