MEDICARE: TOTAL MEDICAL SUPPLY CO INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	00820000934	OTHER	MN	MEDICA

General Provider Information

NPI Number	:	1437186707
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL MEDICAL SUPPLY CO INC

Provider Business Mailing Address
First Line	:	7777 HIGHWAY 65 NE
Second Line	:	SUITE F
City	:	SPRING LAKE PARK
State	:	MN
Zip	:	55432-2851
Country	:	US
Telephone Number	:	763-784-6140
Fax Number	:	763-780-3151

Provider Business Practice Location Address
First Line	:	7777 HIGHWAY 65 NE
Second Line	:	SUITE F
City	:	SPRING LAKE PARK
State	:	MN
Zip	:	55432-2851
Country	:	US
Telephone Number	:	763-784-6140
Fax Number	:	763-780-3151

Authorized Official
Title or Position	:	DELEGATED OFFICIAL
Name	:	JEREMY R JOHNSON
Credential	:
Telephone Number	:	763-784-6140

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	05/02/2014

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