MEDICARE: SHALEM MEDICAL SUPPLIES

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	332BX2000X	Oxygen Equipment & Supplies (DME)

General Provider Information

NPI Number	:	1174791768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHALEM MEDICAL SUPPLIES

Provider Business Mailing Address
First Line	:	PO BOX 850436
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75185-0436
Country	:	US
Telephone Number	:	817-698-9797
Fax Number	:	817-887-2305

Provider Business Practice Location Address
First Line	:	707 NORTH FWY
Second Line	:	SUITE 120
City	:	FORT WORTH
State	:	TX
Zip	:	76102-1702
Country	:	US
Telephone Number	:	817-698-9797
Fax Number	:	817-887-2305

Authorized Official
Title or Position	:	DIRECTOR-1
Name	:	MR. JOHNSON GEORGE
Credential	:
Telephone Number	:	972-222-9263

Provider Enumeration Date	:	02/15/2008
Last Update Date	:	02/15/2008

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Directions to “SHALEM MEDICAL SUPPLIES ” Practice Location

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