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General NPI Number Information
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NPI Number | 1225023898
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Entity Type | Organization
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Legal Business Name | PERSONAL MEDICAL SUPPLY, INC.
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Dates
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Enumeration Date | 09/20/2005
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Last Update Date | 10/17/2014
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Provider Practice Location Address
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Address Line | 373 W 1ST DR
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City | DECATUR
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State | IL
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Zip | 62521-5207
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Country | US
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Telephone | 217-422-1271
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Fax | 217-422-7066
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Provider Business Mailing Address
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Address Line | 373 W 1ST DR
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City | DECATUR
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State | IL
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Zip | 62521-5207
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Country | US
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Telephone | 217-422-1271
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Fax | 217-422-7066
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Authorized Official
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Title or Position | OWNER
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Name | SHARON A MC CHANCY
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Credential |
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Telephone | 217-422-1271
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 203-000093
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License Number State | IL
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