1336145796 NPI number — JOHNSON MEMORIAL HEALTH SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336145796 NPI number — JOHNSON MEMORIAL HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHNSON MEMORIAL HEALTH SERVICES
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:
DAWSON CLINIC
Provider Other Organization Name Type Code:
3
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:
1336145796
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1282 WALNUT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DAWSON
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56232-2333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-769-4393
Provider Business Mailing Address Fax Number:
320-769-2972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1282 WALNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAWSON
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-769-4393
Provider Business Practice Location Address Fax Number:
320-769-2972
Provider Enumeration Date:
06/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
SARA
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OFFICE
Authorized Official Telephone Number:
320-312-2118

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 692320800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".




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