1760654453 NPI number — INTEGRATED HEALTH CENTER, INC.

Table of content: MICHAEL ALANDO JOHNSON M.D. (NPI 1427017490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760654453 NPI number — INTEGRATED HEALTH CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATED HEALTH CENTER, INC.
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:
1760654453
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
418 3RD AVE E STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALEXANDRIA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
56308-1574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
320-762-2311
Provider Business Mailing Address Fax Number:
320-762-8942

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
418 3RD AVE E STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALEXANDRIA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
56308-1574
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
320-762-2311
Provider Business Practice Location Address Fax Number:
320-762-8942
Provider Enumeration Date:
04/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
KLEPETKA
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
JAMES
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
320-762-2311

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , 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)





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