Provider Demographics
NPI:1912922857
Name:JALOPY SHOPPE, INC
Entity Type:Organization
Organization Name:JALOPY SHOPPE, INC
Other - Org Name:PRAXAIR HEALTHCARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:KALTRIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-837-2330
Mailing Address - Street 1:203 E 6100 S
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84107-7302
Mailing Address - Country:US
Mailing Address - Phone:801-261-7139
Mailing Address - Fax:801-288-5906
Practice Address - Street 1:459 THIS WAY ST
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-5143
Practice Address - Country:US
Practice Address - Phone:979-297-7014
Practice Address - Fax:409-654-2068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2009-02-11
Deactivation Date:2008-12-26
Deactivation Code:
Reactivation Date:2009-02-11
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1113458-03Medicaid
TX0117251-01Medicaid
TX1113458-03Medicaid