1992701700 NPI number — SUSAN S JOHNSON MD AND BRIAN L JOHNSON MD PC

Table of content: (NPI 1992701700)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992701700 NPI number — SUSAN S JOHNSON MD AND BRIAN L JOHNSON MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUSAN S JOHNSON MD AND BRIAN L JOHNSON MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992701700
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4700 FORUM BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLUMBIA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65203-5654
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-449-4936
Provider Business Mailing Address Fax Number:
573-449-6795

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
103 RIPLEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65201-5738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-442-9944
Provider Business Practice Location Address Fax Number:
573-442-5345
Provider Enumeration Date:
06/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
573-442-9944

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DB6476 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com