1598039505 NPI number — STANCIL E.D. JOHNSON, M.D, A PROFESSIONAL CORPORATION

Table of content: (NPI 1598039505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598039505 NPI number — STANCIL E.D. JOHNSON, M.D, A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STANCIL E.D. JOHNSON, M.D, A PROFESSIONAL CORPORATION
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:
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:
1598039505
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 5396
Provider Second Line Business Mailing Address:
CARMEL POST OFFICE
Provider Business Mailing Address City Name:
CARMEL
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93921
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-625-2626
Provider Business Mailing Address Fax Number:
831-625-1245

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
JUNIPERO ST BTWN 4TH & 5TH ST
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
CARMEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-625-2626
Provider Business Practice Location Address Fax Number:
831-625-1245
Provider Enumeration Date:
03/08/2012

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
STANCIL
Authorized Official Middle Name:
E.D.
Authorized Official Title or Position:
DOCTOR, M.D.
Authorized Official Telephone Number:
831-625-2626

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  C28935 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: C289350-CA , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: C289350CA . This is a "MC LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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