1124443403 NPI number — CARELON MEDICAL PARTNERS, PC

Table of content: MR. STEVEN LEE JOHNSON MA, LPC, NCC (NPI 1841218427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124443403 NPI number — CARELON MEDICAL PARTNERS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARELON MEDICAL PARTNERS, PC
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:
ASPIRE HEALTH MEDICAL PARTNERS, PC
Provider Other Organization Name Type Code:
4
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:
1124443403
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12900 PARK PLAZA DR STE 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CERRITOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90703-9329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-622-2800
Provider Business Mailing Address Fax Number:
562-741-4479

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22 CENTURY BLVD STE 220
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NASHVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37214-3787
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-454-9850
Provider Business Practice Location Address Fax Number:
562-741-4479
Provider Enumeration Date:
02/24/2014

Additional Information

Authorized Official

Authorized Official Last Name:
ALBION
Authorized Official First Name:
TIMOTHY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
224-234-5025

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 105563900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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