MEDICARE: DR. NANCY J SHORT MD

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	207Q00000X	Family Medicine Physician	036103076	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	151651	OTHER	IOWA HEALTH SOLUTIONS
2	059704	OTHER	HEALTH ALLIANCE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	IL01F5	OTHER	JOHN DEERE HEALTH PLAN

General Provider Information

NPI Number	:	1134125032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY J SHORT MD

Provider Business Mailing Address
First Line	:	4360 KENNEDY DRIVE
Second Line	:	SUITE 1
City	:	EAST MOLINE
State	:	IL
Zip	:	61244
Country	:	US
Telephone Number	:	309-792-6090
Fax Number	:	309-792-6097

Provider Business Practice Location Address
First Line	:	4360 KENNEDY DR
Second Line	:	SUITE 1
City	:	EAST MOLINE
State	:	IL
Zip	:	61244-4287
Country	:	US
Telephone Number	:	309-743-7313
Fax Number	:	309-765-7999

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	11/18/2011

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