Provider Demographics
NPI:1457598872
Name:SHALEM MEDICAL SUPPLIES, INC
Entity Type:Organization
Organization Name:SHALEM MEDICAL SUPPLIES, INC
Other - Org Name:SHALEM MEDICAL SUPPLIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:K
Authorized Official - Last Name:CHERIAN
Authorized Official - Suffix:
Authorized Official - Credentials:NONE
Authorized Official - Phone:704-315-5980
Mailing Address - Street 1:6636 E. W.T. HARRIS BLVD
Mailing Address - Street 2:SUITE # L
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28215
Mailing Address - Country:US
Mailing Address - Phone:704-315-5980
Mailing Address - Fax:877-292-2817
Practice Address - Street 1:6636 E WT HARRIS BLVD
Practice Address - Street 2:SUITE # L
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28215-5133
Practice Address - Country:US
Practice Address - Phone:704-315-5980
Practice Address - Fax:877-292-2817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-08
Last Update Date:2009-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNONE YETOtherUNKNOWN