Provider Demographics
NPI:1386906022
Name:SMALLWOOD ENTERPRISES INC.
Entity type:Organization
Organization Name:SMALLWOOD ENTERPRISES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMALLWOOD
Authorized Official - Suffix:SR
Authorized Official - Credentials:HEARING INSTRUMENT D
Authorized Official - Phone:217-422-2233
Mailing Address - Street 1:155 N WATER ST
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62523-1309
Mailing Address - Country:US
Mailing Address - Phone:217-422-2233
Mailing Address - Fax:217-422-2233
Practice Address - Street 1:3400 QUINCY MALL
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:IL
Practice Address - Zip Code:62301-4640
Practice Address - Country:US
Practice Address - Phone:217-228-1974
Practice Address - Fax:217-228-1974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-08
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0016332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment