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General NPI Number Information
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NPI Number | 1124116561
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Entity Type | Organization
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Legal Business Name | THE MED SHOP
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 110 N . WALNUT
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City | JEFFERSON
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State | TX
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Zip | 75657
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Country | US
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Telephone | 903-665-2525
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Fax | 903-665-2526
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Provider Business Mailing Address
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Address Line | 110 N WALNUT
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City | JEFFERSON
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State | TX
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Zip | 75657
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Country | US
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Telephone | 903-665-2525
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Fax | 903-665-2526
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Authorized Official
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Title or Position | OWNER
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Name | MR. GEORGE E TEEL
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Credential |
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Telephone | 903-639-3508
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 25114
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 25114
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License Number State | TX
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