MEDICARE: JEREMY SCOTT JOHNSTON PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0000X	Pain Medicine Physician	PA168476	OR
2	208VP0014X	Interventional Pain Medicine Physician	PA168476	OR
3	363A00000X	Physician Assistant	PA168476	OR

General Provider Information

NPI Number	:	1013286335
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY SCOTT JOHNSTON PA-C

Provider Business Mailing Address
First Line	:	2852 WILLAMETTE ST STE 400
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97405-8200
Country	:	US
Telephone Number	:	541-246-3400
Fax Number	:

Provider Business Practice Location Address
First Line	:	1605 OAK ST
Second Line	:
City	:	EUGENE
State	:	OR
Zip	:	97401-4022
Country	:	US
Telephone Number	:	541-246-3400
Fax Number	:	541-246-3342

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/14/2011
Last Update Date	:	05/21/2025

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