MEDICARE: SHALEM MEDICAL SUPPLIES, 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		NC
2	332BX2000X	Oxygen Equipment & Supplies (DME)		NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NONE YET	OTHER	NC	UNKNOWN

General Provider Information

NPI Number	:	1457598872
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHALEM MEDICAL SUPPLIES, INC

Provider Business Mailing Address
First Line	:	6636 E. W.T. HARRIS BLVD
Second Line	:	SUITE # L
City	:	CHARLOTTE
State	:	NC
Zip	:	28215
Country	:	US
Telephone Number	:	704-315-5980
Fax Number	:	877-292-2817

Provider Business Practice Location Address
First Line	:	6636 E WT HARRIS BLVD
Second Line	:	SUITE # L
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-5133
Country	:	US
Telephone Number	:	704-315-5980
Fax Number	:	877-292-2817

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. GEORGE K CHERIAN
Credential	:	NONE
Telephone Number	:	704-315-5980

Provider Enumeration Date	:	01/08/2009
Last Update Date	:	01/08/2009

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Directions to “SHALEM MEDICAL SUPPLIES, INC ” Practice Location

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