=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225365539
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHORT FURNITURE CO., INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2009
-----------------------------------------------------
Last Update Date | 11/06/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 319 N STATE ST
-----------------------------------------------------
City | LITCHFIELD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62056-2002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-324-2117
-----------------------------------------------------
Fax | 217-324-7176
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 319 N STATE ST
-----------------------------------------------------
City | LITCHFIELD
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 62056-2002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 217-324-2117
-----------------------------------------------------
Fax | 217-324-7176
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. WILLIAM W SHORT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 217-324-2117
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 02032422
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------