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General NPI Number Information
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NPI Number | 1669470241
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Entity Type | Organization
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Legal Business Name | THE MEDICAL SHOP, INC
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Dates
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Enumeration Date | 07/08/2005
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 3840 W NORTHWEST HWY SUITE 400
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City | DALLAS
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State | TX
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Zip | 75220-5162
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Country | US
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Telephone | 214-357-5229
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Fax | 214-357-5488
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Provider Business Mailing Address
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Address Line | 3840 W NORTHWEST HWY SUITE 400
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City | DALLAS
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State | TX
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Zip | 75220-5162
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Country | US
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Telephone | 214-357-5229
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Fax | 214-357-5488
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Authorized Official
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Title or Position | CEO
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Name | EMIL GEORGIO CERULLO
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Credential |
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Telephone | 214-357-5229
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 247100000X
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Taxonomy Name | Radiologic Technologist
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License Number | R21910
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 2471C3401X
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Taxonomy Name | Computed Tomography Radiologic Technologist
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License Number | R21910
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 2471C3402X
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Taxonomy Name | Radiography Radiologic Technologist
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License Number | R21910
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License Number State | TX
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Taxonomy #4
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Taxonomy Code | 2471M1202X
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Taxonomy Name | Magnetic Resonance Imaging Radiologic Technologist
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License Number | R21910
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License Number State | TX
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