1760640064 NPI number — PAMELA D. JOHNSON, M.D., P.C.

Table of content: (NPI 1760640064)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760640064 NPI number — PAMELA D. JOHNSON, M.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAMELA D. JOHNSON, M.D., P.C.
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:
1760640064
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
245 BARCLAY CIR
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
ROCHESTER HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48307-5815
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-852-2040
Provider Business Mailing Address Fax Number:
248-853-7258

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
245 BARCLAY CIR
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
ROCHESTER HILLS
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48307-5815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-852-2040
Provider Business Practice Location Address Fax Number:
248-853-7258
Provider Enumeration Date:
05/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
C E O
Authorized Official Telephone Number:
248-852-2040

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  PJ048870 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: B8910 . This is a "M-CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 102263 . This is a "PREFERRED CHOICES PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2422609003 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4133392 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 74717A . This is a "HEALTH ALLIANCE PLAN" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 0633185 . This is a "BC/BS OF MI" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com