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

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 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".




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