Provider Demographics
NPI:1760436943
Name:SHANET MEDICAL SOURCE INC
Entity Type:Organization
Organization Name:SHANET MEDICAL SOURCE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ENE
Authorized Official - Middle Name:E
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-726-8525
Mailing Address - Street 1:11246 S POST OAK RD
Mailing Address - Street 2:STE 208
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77035-5745
Mailing Address - Country:US
Mailing Address - Phone:713-726-8525
Mailing Address - Fax:713-726-8545
Practice Address - Street 1:11246 S POST OAK RD
Practice Address - Street 2:STE 208
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77035-5745
Practice Address - Country:US
Practice Address - Phone:713-726-8525
Practice Address - Fax:713-726-8545
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0061756332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies