1225086655 NPI number — LENWORTH N JOHNSON MD

Table of content: LENWORTH N JOHNSON MD (NPI 1225086655)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225086655 NPI number — LENWORTH N JOHNSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
LENWORTH
Provider Middle Name:
N
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1225086655
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 HOPPIN ST
Provider Second Line Business Mailing Address:
CORO WEST/STE 202
Provider Business Mailing Address City Name:
PROVIDENCE
Provider Business Mailing Address State Name:
RI
Provider Business Mailing Address Postal Code:
02903-4141
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
401-444-6551
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 HOPPIN ST
Provider Second Line Business Practice Location Address:
CORO WEST/STE 202
Provider Business Practice Location Address City Name:
PROVIDENCE
Provider Business Practice Location Address State Name:
RI
Provider Business Practice Location Address Postal Code:
02903-4141
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
401-444-6551
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  R7N60 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: MD14426 , registered in the state of RI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 202887907 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 804021 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 9312 . This is a "BLUE SHIELD/BLUE CHOICE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 2086330901 . This is a "KANSAS MEDICAID" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 131956 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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