Provider Demographics
NPI:1376629568
Name:MEDICAL SHOPPE INC
Entity type:Organization
Organization Name:MEDICAL SHOPPE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:BURGETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-446-2206
Mailing Address - Street 1:101 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1542
Mailing Address - Country:US
Mailing Address - Phone:740-446-2206
Mailing Address - Fax:740-446-3509
Practice Address - Street 1:101 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631
Practice Address - Country:US
Practice Address - Phone:740-446-2206
Practice Address - Fax:740-446-3509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0329782Medicaid
OH0329782Medicaid