1518939974 NPI number — MR. JAMES FRED JOHNSON MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518939974 NPI number — MR. JAMES FRED JOHNSON MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

JOHNSON

Provider First Name:

JAMES

Provider Middle Name:

FRED

Provider Name Prefix Text:

MR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1518939974

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/28/2010

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2301 25TH ST S

Provider Second Line Business Mailing Address:

SUITE I

Provider Business Mailing Address City Name:

FARGO

Provider Business Mailing Address State Name:

ND

Provider Business Mailing Address Postal Code:

58103

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

701-241-9300

Provider Business Mailing Address Fax Number:

701-235-4525

Provider First Line Business Practice Location Address:

2301 25TH ST S

Provider Second Line Business Practice Location Address:

SUITE I

Provider Business Practice Location Address City Name:

FARGO

Provider Business Practice Location Address State Name:

ND

Provider Business Practice Location Address Postal Code:

58103

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

701-241-9300

Provider Business Practice Location Address Fax Number:

701-235-4525

Provider Enumeration Date:

02/01/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207X00000X , with the licence number:  3782 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 207X00000X , with the licence number: 31925 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207X00000X , with the licence number: 5131 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 14183 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
• Identifier: 0023210 . This is a "WELLMARK BCBS" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".
• Identifier: 58A11JO . This is a "MN BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 594741014527 . This is a "PREFERRED ONE COMMUNITY HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 840563800 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: HP19542 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
• Identifier: JOH23210 . This is a "BCBS ND" identifier , issued by the state of ( ND ) . This identifiers is of the category "OTHER".
• Identifier: 0900489 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
• Identifier: 200026912 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 6402130 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".