Provider Demographics
NPI:1043215510
Name:TOTAL MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:TOTAL MEDICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:WEDGEWORTH
Authorized Official - Suffix:SR
Authorized Official - Credentials:RT,MS
Authorized Official - Phone:708-335-3775
Mailing Address - Street 1:PO BOX 463
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-0463
Mailing Address - Country:US
Mailing Address - Phone:708-335-3775
Mailing Address - Fax:708-335-3778
Practice Address - Street 1:1503 WEST 174TH STREET
Practice Address - Street 2:
Practice Address - City:EAST HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-1758
Practice Address - Country:US
Practice Address - Phone:708-335-3775
Practice Address - Fax:708-335-3778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-20
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203-000627332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL3961850001Medicare NSC