MEDICARE: MR. DARREN T SHORT RRT

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	227900000X	Registered Respiratory Therapist	30006893A	IN

General Provider Information

NPI Number	:	1184811150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DARREN T SHORT RRT

Provider Business Mailing Address
First Line	:	11142 17 MILE RD
Second Line	:
City	:	CEDAR SPRINGS
State	:	MI
Zip	:	49319-9749
Country	:	US
Telephone Number	:	269-225-8030
Fax Number	:

Provider Business Practice Location Address
First Line	:	11142 17 MILE RD NE
Second Line	:
City	:	CEDAR SPRINGS
State	:	MI
Zip	:	49319-9749
Country	:	US
Telephone Number	:	269-225-8030
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2007
Last Update Date	:	10/03/2007

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