Provider Demographics
NPI:1508960907
Name:THERAPEUTIC MEDICAL SUPPLY INC
Entity Type:Organization
Organization Name:THERAPEUTIC MEDICAL SUPPLY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-945-0040
Mailing Address - Street 1:7222 W NORTHWIND ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-2596
Mailing Address - Country:US
Mailing Address - Phone:316-945-0040
Mailing Address - Fax:
Practice Address - Street 1:7222 W NORTHWIND ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-2596
Practice Address - Country:US
Practice Address - Phone:316-945-0040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS48659OtherBLUE CROSS & BLUE SHIELD
KS48659OtherBLUE CROSS & BLUE SHIELD