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NPI Code Detail

MEDICARE: THE MEDICAL SHOP, INC

MEDICARE: THE MEDICAL SHOP, INC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1247100000XRadiologic TechnologistR21910TX
22471C3401XComputed Tomography Radiologic TechnologistR21910TX
32471C3402XRadiography Radiologic TechnologistR21910TX
42471M1202XMagnetic Resonance Imaging Radiologic TechnologistR21910TX

General Provider Information

NPI Number : 1669470241
Entity Type Code : Organization
Provider Name (Legal Business Name) : THE MEDICAL SHOP, INC
Provider Business Mailing Address
First Line : 3840 W NORTHWEST HWY
Second Line : SUITE 400
City : DALLAS
State : TX
Zip : 75220-5162
Country : US
Telephone Number : 214-357-5229
Fax Number : 214-357-5488
Provider Business Practice Location Address
First Line : 3840 W NORTHWEST HWY
Second Line : SUITE 400
City : DALLAS
State : TX
Zip : 75220-5162
Country : US
Telephone Number : 214-357-5229
Fax Number : 214-357-5488
Authorized Official
Title or Position : CEO
Name : EMIL GEORGIO CERULLO
Credential :
Telephone Number : 214-357-5229
Provider Enumeration Date : 07/08/2005
Last Update Date : 09/11/2025

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Directions to “THE MEDICAL SHOP, INC ” Practice Location

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