Provider Demographics
NPI:1366623084
Name:SHALOM DME SUPPLIER INC.
Entity Type:Organization
Organization Name:SHALOM DME SUPPLIER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ALISA
Authorized Official - Middle Name:
Authorized Official - Last Name:GHEREGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-279-8066
Mailing Address - Street 1:2611 N 7TH ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-1002
Mailing Address - Country:US
Mailing Address - Phone:602-279-8066
Mailing Address - Fax:602-274-6906
Practice Address - Street 1:2611 N 7TH ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-1002
Practice Address - Country:US
Practice Address - Phone:602-279-8066
Practice Address - Fax:602-274-6906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-21
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20183915332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies