Provider Demographics
NPI:1174791768
Name:SHALEM MEDICAL SUPPLIES
Entity type:Organization
Organization Name:SHALEM MEDICAL SUPPLIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR-1
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNSON
Authorized Official - Middle Name:
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-222-9263
Mailing Address - Street 1:PO BOX 850436
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75185-0436
Mailing Address - Country:US
Mailing Address - Phone:817-698-9797
Mailing Address - Fax:817-887-2305
Practice Address - Street 1:707 NORTH FWY
Practice Address - Street 2:SUITE 120
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-1702
Practice Address - Country:US
Practice Address - Phone:817-698-9797
Practice Address - Fax:817-887-2305
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHALEM MEDICAL SUPPLIES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies