Healthcare Provider Details

I. General information

NPI: 1477606713
Provider Name (Legal Business Name): JOHNSTON MEDICAL SUPPLY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 S 48TH ST #105
TEMPE AZ
85282-1019
US

IV. Provider business mailing address

2105 S 48TH ST #105
TEMPE AZ
85282-1019
US

V. Phone/Fax

Practice location:
  • Phone: 602-264-1201
  • Fax: 602-264-4970
Mailing address:
  • Phone: 602-264-1201
  • Fax: 602-264-4970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number332B00000X
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number332BC3200X
License Number State
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number335E00000X
License Number State

VIII. Authorized Official

Name: MS. REBECCA LOUISE HOLLY
Title or Position: OWNER
Credential:
Phone: 602-264-1201