Provider Demographics
NPI:1700883972
Name:TOLEDO MEDICAL SUPPLY
Entity Type:Organization
Organization Name:TOLEDO MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAUGHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-208-3349
Mailing Address - Street 1:5916 FAIRFIELD AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-1914
Mailing Address - Country:US
Mailing Address - Phone:318-861-1346
Mailing Address - Fax:318-861-1346
Practice Address - Street 1:5916 FAIRFIELD AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-1914
Practice Address - Country:US
Practice Address - Phone:318-861-1346
Practice Address - Fax:318-861-1346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4316915001332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies