1194982504 NPI number — MR. JAMES WILLIAM JOHNSON MS CCCA

Table of content: MR. JAMES WILLIAM JOHNSON MS CCCA (NPI 1194982504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194982504 NPI number — MR. JAMES WILLIAM JOHNSON MS CCCA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
JAMES
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MS CCCA
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:
1194982504
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2385 E PRATER WAY
Provider Second Line Business Mailing Address:
ADVANCE AUDIOLOGY
Provider Business Mailing Address City Name:
SPARKS
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89434-7688
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-358-4007
Provider Business Mailing Address Fax Number:
775-358-4405

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2385 E PRATER WAY SUITE 205
Provider Second Line Business Practice Location Address:
ADVANCE AUDIOLOGY
Provider Business Practice Location Address City Name:
SPARKS
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89434-7688
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-358-4007
Provider Business Practice Location Address Fax Number:
775-358-4405
Provider Enumeration Date:
05/22/2008

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: 231H00000X , with the licence number:  00686394 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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