1528177367 NPI number — JAMES MARTIN JOHNSTON MD

Table of content: (NPI 1710009014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528177367 NPI number — JAMES MARTIN JOHNSTON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSTON
Provider First Name:
JAMES
Provider Middle Name:
MARTIN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1528177367
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
850 HARVARD WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RENO
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89502-2055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
775-982-5262
Provider Business Mailing Address Fax Number:
775-982-5496

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
75 PRINGLE WAY STE 505
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENO
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89502-1469
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
775-982-5000
Provider Business Practice Location Address Fax Number:
775-982-3900
Provider Enumeration Date:
08/29/2006

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: 2080P0207X , with the licence number:  059801 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0207X , with the licence number: 17447 , 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)

  • Identifier: 404279 . This is a "WELLCARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 792665328E , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 11566679 . This is a "CAQH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 792665328C , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: G59801 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00414570 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 01067533 . This is a "AMERIGROUP" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 792665328B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 792665328D , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 792665328A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com