{"npi":"1275847725","type":"NPI-2","status":"active","name":{"display":"Medsource LLC","other":[],"organization_name":"MEDSOURCE LLC","authorised_official":"Eric Rohde"},"specialty":{"primary_taxonomy":"332B00000X","primary_taxonomy_description":"Durable Medical Equipment & Medical Supplies","slug":"durable-medical-equipment-medical-supplies","schema_org_specialty":null,"all":[{"code":"332B00000X","description":"Durable Medical Equipment & Medical Supplies","primary":true,"state":"IL","license":"203.001082"}]},"addresses":[{"purpose":"LOCATION","street_1":"5300 S 108TH ST STE 19","city":"HALES CORNERS","state":"WI","postal_code":"531301368","country_code":"US","phone":"2624464850","fax":"2624464851"},{"purpose":"MAILING","street_1":"PO BOX 1248","city":"BLOOMINGTON","state":"IL","postal_code":"617021248","country_code":"US","phone":"3096647930","fax":"3096647931"}],"license":{"state":"IL","number":"203.001082"},"identifiers":[{"type_code":"01","label":"Other","value":"203.001082","state":"IL","issuer":"LICENSE"}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20110120000664","type_code":"30-51","type_desc":"DME SUPPLIER - MEDICAL SUPPLY COMPANY WITH ORTHOTIC PERSONNEL","state":"WI","pac_id":"3072726967"}]},"enumeration_date":"2010-07-27","last_updated":"2020-11-30","_meta":{"source":"NPPES","snapshot_date":"2020-11-30","doc_url":"https://findmynpi.com/api"}}