| Nancy J Short Md Llc | |
|
4360 Kennedy Dr Suite 1 East Moline IL 61244-4287 | |
| (309) 792-6090 | |
| (309) 792-6097 |
| Full Name | Nancy J Short Md Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 4360 Kennedy Dr, East Moline, Illinois |
| Authorized Official Name and Position | Nancy J Short (OWNER) |
| Authorized Official Contact | 3097926090 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Nancy J Short Md Llc 4360 Kennedy Dr Suite 1 East Moline IL 61244-4287 Ph: (309) 792-6090 | Nancy J Short Md Llc 4360 Kennedy Dr Suite 1 East Moline IL 61244-4287 Ph: (309) 792-6090 |
| NPI Number | 1588732150 |
|---|---|
| Provider Enumeration Date | 12/01/2006 |
| Last Update Date | 10/30/2008 |
| Medicare PECOS PAC ID | 9133120280 |
|---|---|
| Medicare Enrollment ID | O20070116000582 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588732150 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036103076 (Illinois) | Primary |
| Provider Name | Nancy J Short |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134125032 PECOS PAC ID: 5597760140 Enrollment ID: I20061003000620 |
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