Provider Demographics
NPI:1093712770
Name:SHELBY HOME MEDICAL EQUIPMENT, INC.
Entity Type:Organization
Organization Name:SHELBY HOME MEDICAL EQUIPMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:KIRK
Authorized Official - Last Name:CHASTAIN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:217-429-0660
Mailing Address - Street 1:PO BOX 4000
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62525-4000
Mailing Address - Country:US
Mailing Address - Phone:217-429-0660
Mailing Address - Fax:217-429-0688
Practice Address - Street 1:1303 W SOUTH 2ND ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62565-1711
Practice Address - Country:US
Practice Address - Phone:217-774-2424
Practice Address - Fax:217-774-2554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid
4593430001Medicare ID - Type Unspecified