Provider Demographics
NPI:1144231630
Name:MED-SHOP OF HUGHES SPRINGS INC
Entity Type:Organization
Organization Name:MED-SHOP OF HUGHES SPRINGS INC
Other - Org Name:THE MED SHOP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:TEEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-639-3508
Mailing Address - Street 1:PO BOX 279
Mailing Address - Street 2:
Mailing Address - City:HUGHES SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75656-0279
Mailing Address - Country:US
Mailing Address - Phone:903-639-3508
Mailing Address - Fax:
Practice Address - Street 1:111 E 2ND
Practice Address - Street 2:
Practice Address - City:HUGHES SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75656-2596
Practice Address - Country:US
Practice Address - Phone:903-639-3508
Practice Address - Fax:903-639-7187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2017-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
TX154783336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2100061OtherPK
TX013950301Medicaid
TX148403Medicaid
TX013950301Medicaid
4585418OtherNCPDP PROVIDER IDENTIFICATION NUMBER