Provider Demographics
NPI:1164697298
Name:MATTOON FURNITURE
Entity Type:Organization
Organization Name:MATTOON FURNITURE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANETTE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:MAROON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-234-7879
Mailing Address - Street 1:1803 LAKE LAND BLVD
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-5919
Mailing Address - Country:US
Mailing Address - Phone:217-234-7879
Mailing Address - Fax:217-234-7890
Practice Address - Street 1:1803 LAKE LAND BLVD
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-5919
Practice Address - Country:US
Practice Address - Phone:217-234-7879
Practice Address - Fax:217-234-7890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies