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General NPI Number Information
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NPI Number | 1649382078
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Entity Type | Organization
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Legal Business Name | MED SHOP TOTAL CARE, INC
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 08/22/2022
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Provider Practice Location Address
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Address Line | 1071 HWY 271 NORTH SUITE 103
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City | GILMER
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State | TX
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Zip | 75644-3560
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Country | US
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Telephone | 903-843-5687
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Fax | 903-843-5689
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Provider Business Mailing Address
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Address Line | PO BOX 927
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City | GILMER
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State | TX
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Zip | 75644-0927
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Country | US
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Telephone | 903-849-5687
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Fax | 903-843-5689
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | JAN DOWNING
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Credential | RN
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Telephone | 903-236-0090
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 0043246
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License Number State | TX
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