Provider Demographics
NPI:1689692428
Name:THE FURNITURE DOCTOR
Entity type:Organization
Organization Name:THE FURNITURE DOCTOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:GRUESBECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-427-5646
Mailing Address - Street 1:PO BOX 123
Mailing Address - Street 2:
Mailing Address - City:CEDAR LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:48812-0123
Mailing Address - Country:US
Mailing Address - Phone:989-427-5646
Mailing Address - Fax:989-427-5053
Practice Address - Street 1:6282 E HOWARD CITY EDMORE RD
Practice Address - Street 2:
Practice Address - City:VESTABURG
Practice Address - State:MI
Practice Address - Zip Code:48891-9424
Practice Address - Country:US
Practice Address - Phone:989-427-5646
Practice Address - Fax:989-427-5053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-18
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5742390001Medicare NSC