=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083875025
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DONAHUE FURNITURE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/23/2008
-----------------------------------------------------
Last Update Date | 06/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 WALL ST
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01803-4759
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-272-9830
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 WALL ST
-----------------------------------------------------
City | BURLINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01803-4759
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | KEVIN CRAMPTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 781-272-9830
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332BC3200X
-----------------------------------------------------
Taxonomy Name | Customized Equipment (DME)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------