MEDICARE: MATTOON FURNITURE

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1164697298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATTOON FURNITURE

Provider Business Mailing Address
First Line	:	1803 LAKE LAND BLVD
Second Line	:
City	:	MATTOON
State	:	IL
Zip	:	61938-5919
Country	:	US
Telephone Number	:	217-234-7879
Fax Number	:	217-234-7890

Provider Business Practice Location Address
First Line	:	1803 LAKE LAND BLVD
Second Line	:
City	:	MATTOON
State	:	IL
Zip	:	61938-5919
Country	:	US
Telephone Number	:	217-234-7879
Fax Number	:	217-234-7890

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. JANETTE LYNN MAROON
Credential	:
Telephone Number	:	217-234-7879

Provider Enumeration Date	:	04/29/2008
Last Update Date	:	04/29/2008

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Directions to “MATTOON FURNITURE ” Practice Location

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