MEDICARE: SHELBY HOME MEDICAL EQUIPMENT, 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		IL

General Provider Information

NPI Number	:	1093712770
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHELBY HOME MEDICAL EQUIPMENT, INC.

Provider Business Mailing Address
First Line	:	PO BOX 4000
Second Line	:
City	:	DECATUR
State	:	IL
Zip	:	62525-4000
Country	:	US
Telephone Number	:	217-429-0660
Fax Number	:	217-429-0688

Provider Business Practice Location Address
First Line	:	1303 W SOUTH 2ND ST
Second Line	:
City	:	SHELBYVILLE
State	:	IL
Zip	:	62565-1711
Country	:	US
Telephone Number	:	217-774-2424
Fax Number	:	217-774-2554

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. STEVEN KIRK CHASTAIN
Credential	:	R.PH.
Telephone Number	:	217-429-0660

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	08/22/2020

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