1316099187 NPI number — MR. ALEXANDER JOHNSON CP CERTIFIED PROSTHE

Table of content: MR. ALEXANDER JOHNSON CP CERTIFIED PROSTHE (NPI 1316099187)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316099187 NPI number — MR. ALEXANDER JOHNSON CP CERTIFIED PROSTHE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
ALEXANDER
Provider Middle Name:
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CP CERTIFIED PROSTHE
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:
1316099187
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
66 SEEKONK CROSSROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREAT BARRINGTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01230-1569
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-528-3562
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
99 FIRST ST
Provider Second Line Business Practice Location Address:
BERKSHIRE PROSTHETIC CENTER
Provider Business Practice Location Address City Name:
PITTSFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01201-4745
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-442-5381
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/18/2007

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: 225000000X , with the licence number:  P1026 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1524631 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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