Provider Demographics
NPI:1649382078
Name:MED SHOP TOTAL CARE, INC
Entity Type:Organization
Organization Name:MED SHOP TOTAL CARE, INC
Other - Org Name:MED SHOP MEDICAL DEPOT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DOWNING
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:903-236-0090
Mailing Address - Street 1:PO BOX 927
Mailing Address - Street 2:
Mailing Address - City:GILMER
Mailing Address - State:TX
Mailing Address - Zip Code:75644-0927
Mailing Address - Country:US
Mailing Address - Phone:903-849-5687
Mailing Address - Fax:903-843-5689
Practice Address - Street 1:1071 HWY 271 NORTH
Practice Address - Street 2:SUITE 103
Practice Address - City:GILMER
Practice Address - State:TX
Practice Address - Zip Code:75644-3560
Practice Address - Country:US
Practice Address - Phone:903-843-5687
Practice Address - Fax:903-843-5689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
TX0043246332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX515236OtherBCBS DME PROVIDER NUMBER
TX091540701Medicaid
TX=========003OtherHUMANA MILITARY HEALTH
0248120001Medicare NSC
TX016051701Medicaid