Provider Demographics
NPI:1992720783
Name:JALOPY SHOPPE INC
Entity type:Organization
Organization Name:JALOPY SHOPPE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 1:18227 AMMI TRL
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77060-1116
Mailing Address - Country:US
Mailing Address - Phone:281-784-4861
Mailing Address - Fax:281-209-8025
Practice Address - Street 1:105 E MOCKINGBIRD LN # B
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-2073
Practice Address - Country:US
Practice Address - Phone:361-576-4313
Practice Address - Fax:361-576-4326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
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
TX111345802Medicaid
TX0117194-01Medicaid
TX111345802Medicaid