Organization
MED SHOP TOTAL CARE, INC
Active
Other names
Med Shop Medical Depot
Organization subpart
No
Provider details
NPI number
Authorized official
JAN DOWNING RN (VICE PRESIDENT)
(903) 236-0090
Entity
Organization
Contact information
Practice address
472 E LOOP 281, LONGVIEW, TX 75605-7939
(903) 236-0090
(903) 236-0095
Mailing address
472 E LOOP 281, LONGVIEW, TX 75605-7939
(903) 236-0090
(903) 236-0095
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BC3200X
Customized Equipment (DME)
—
—
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
0043245
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
014262201
—
TX
05
—
091540702
—
TX
01
—
519549
BCBS DME NUMBER
TX
Enumeration date
08/31/2006
Last updated
08/22/2022
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