Organization
TOTAL MEDICAL SUPPLY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY RUSSELL JOHNSON PT (OWNER)
(601) 888-3373
Entity
Organization
Contact information
Practice address
558 1ST SOUTH ST, WOODVILLE, MS 39669-3777
(601) 888-3373
(601) 888-4767
Mailing address
12617 WARWICK AVE, BATON ROUGE, LA 70815-6847
(225) 275-6415
(225) 275-6415
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
06136 11.1
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04700561
—
MS
Enumeration date
12/11/2006
Last updated
08/22/2020
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