1255351110 NPI number — DR. SCOTT RICHARD JOHNSTON M.D.

Table of content: PAULA G HAND LCSW (NPI 1003055773)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255351110 NPI number — DR. SCOTT RICHARD JOHNSTON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSTON
Provider First Name:
SCOTT
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1255351110
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/13/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 HUFF DRIVE
Provider Second Line Business Mailing Address:
JOHNSTON PAIN MANAGEMENT, P.A.
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28546-7325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-353-4414
Provider Business Mailing Address Fax Number:
910-353-2972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 HUFF DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28546-7369
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-353-4414
Provider Business Practice Location Address Fax Number:
910-353-2972
Provider Enumeration Date:
07/20/2006

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: 208VP0014X , with the licence number:  34999 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1255351110 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com