Provider Demographics
NPI:1508856782
Name:MEDICAL EQUIPMENT SHOP INC
Entity Type:Organization
Organization Name:MEDICAL EQUIPMENT SHOP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KENT
Authorized Official - Middle Name:
Authorized Official - Last Name:COEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:830-792-6333
Mailing Address - Street 1:PO BOX 291971
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78029-1971
Mailing Address - Country:US
Mailing Address - Phone:830-792-6333
Mailing Address - Fax:830-792-6311
Practice Address - Street 1:212 QUINLAN ST
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5314
Practice Address - Country:US
Practice Address - Phone:830-792-6333
Practice Address - Fax:830-792-6311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2008-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX011921601Medicaid
TX1093880001Medicare ID - Type Unspecified