MEDICARE: JOHNSON FURNITURE3 INC

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	:	1821334731
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHNSON FURNITURE3 INC

Provider Business Mailing Address
First Line	:	3219 WASHINGTON AVE
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53405-3036
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3219 WASHINGTON AVE
Second Line	:
City	:	RACINE
State	:	WI
Zip	:	53405-3036
Country	:	US
Telephone Number	:	262-637-8514
Fax Number	:	262-635-7114

Authorized Official
Title or Position	:	OWNER
Name	:	MS. ELIZABETH M SPANGENBERG
Credential	:
Telephone Number	:	262-637-8514

Provider Enumeration Date	:	12/20/2012
Last Update Date	:	12/20/2012

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