Healthcare Provider Details

I. General information

NPI: 1811921075
Provider Name (Legal Business Name): JALOPY SHOPPE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 02/11/2009
Certification Date:
Deactivation Date: 12/09/2008
Reactivation Date: 02/11/2009

III. Provider practice location address

201 S COMMERCIAL AVE
COLEMAN TX
76834-4211
US

IV. Provider business mailing address

203 E 6100 S
SALT LAKE CITY UT
84107-7302
US

V. Phone/Fax

Practice location:
  • Phone: 325-625-3478
  • Fax: 409-654-2068
Mailing address:
  • Phone: 801-261-7139
  • Fax: 801-288-5906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: SCOTT KALTRIDER
Title or Position: PRESIDENT
Credential:
Phone: 203-837-2330