1255338232 NPI number — JOHNSON HEALTH CARE, INC. DBA JOHNSON SURGERY CENTER

Table of content: (NPI 1255338232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255338232 NPI number — JOHNSON HEALTH CARE, INC. DBA JOHNSON SURGERY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHNSON HEALTH CARE, INC. DBA JOHNSON SURGERY CENTER
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:
1255338232
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24 BATTLE ST
Provider Second Line Business Mailing Address:
P.O. BOX 750
Provider Business Mailing Address City Name:
SOMERS
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06071-1629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-684-8417
Provider Business Mailing Address Fax Number:
860-684-8420

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
148 HAZARD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENFIELD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06082-4520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-763-7650
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VALENTE
Authorized Official First Name:
ANTHONY
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
860-763-7667

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  0066 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: IR0098 . This is a "HEALTH NET PROVIDER NUMBE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: A487059 . This is a "OXFORD PROVIDER NUMBER" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 122 . This is a "ANTHEM BC/BS PROVIDER NUM" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 775436 . This is a "CONNECTICARE PROVIDER NUM" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".