Healthcare Provider Details

I. General information

NPI: 1184811150
Provider Name (Legal Business Name): DARREN T SHORT RRT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 10/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11142 17 MILE RD NE
CEDAR SPRINGS MI
49319-9749
US

IV. Provider business mailing address

11142 17 MILE RD
CEDAR SPRINGS MI
49319-9749
US

V. Phone/Fax

Practice location:
  • Phone: 269-225-8030
  • Fax:
Mailing address:
  • Phone: 269-225-8030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number30006893A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: