MEDICARE: PERSONAL MEDICAL SUPPLY, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies	203-000093	IL

General Provider Information

NPI Number	:	1225023898
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERSONAL MEDICAL SUPPLY, INC.

Provider Business Mailing Address
First Line	:	373 W 1ST DR
Second Line	:
City	:	DECATUR
State	:	IL
Zip	:	62521-5207
Country	:	US
Telephone Number	:	217-422-1271
Fax Number	:	217-422-7066

Provider Business Practice Location Address
First Line	:	373 W 1ST DR
Second Line	:
City	:	DECATUR
State	:	IL
Zip	:	62521-5207
Country	:	US
Telephone Number	:	217-422-1271
Fax Number	:	217-422-7066

Authorized Official
Title or Position	:	OWNER
Name	:	SHARON A MC CHANCY
Credential	:
Telephone Number	:	217-422-1271

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	10/17/2014

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Directions to “PERSONAL MEDICAL SUPPLY, INC. ” Practice Location

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