1821084047 NPI number — JOHN P JOHNSON PA-C

Table of content: JOHN P JOHNSON PA-C (NPI 1821084047)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821084047 NPI number — JOHN P JOHNSON PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
JOHN
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1821084047
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4376 7TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOLINE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61265-6867
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
309-762-0777
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4376 7TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOLINE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61265-6867
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
309-762-0777
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/22/2005

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: 363AM0700X , with the licence number:  085002074 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 385000978 . This is a "CONTROLLED SUBSTANCE#" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 421060724A3 . This is a "JOHN DEERE HEALTH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: IL01A3 . This is a "JOHN DEERE EDI#" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: Q02637 . This is a "UPIN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 421060724 . This is a "BILLING TAX ID FOR CHC" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 93263 . This is a "IA BC/BS SEEN IN RI" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 93251 . This is a "IA BC/BS SEEN IN MOLINE" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 090218 . This is a "HEALTH ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 242060 . This is a "MIDLAND'S CHOICE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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