Provider Demographics
NPI:1265238778
Name:SHOKR HYDRATION PLLC
Entity type:Organization
Organization Name:SHOKR HYDRATION PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:DORIS
Authorized Official - Last Name:LEDBETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-803-5205
Mailing Address - Street 1:1124 GLADE RD STE 160
Mailing Address - Street 2:
Mailing Address - City:COLLEYVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76034-4294
Mailing Address - Country:US
Mailing Address - Phone:817-984-3460
Mailing Address - Fax:817-984-3463
Practice Address - Street 1:1124 GLADE RD STE 160
Practice Address - Street 2:
Practice Address - City:COLLEYVILLE
Practice Address - State:TX
Practice Address - Zip Code:76034-4294
Practice Address - Country:US
Practice Address - Phone:817-984-3460
Practice Address - Fax:817-984-3463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-24
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center