MEDICARE: THE DR ROY JOHNSON MEDICAL CENTER INC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1093708240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE DR ROY JOHNSON MEDICAL CENTER INC

Provider Business Mailing Address
First Line	:	40 N FLORISSANT RD
Second Line	:
City	:	FERGUSON
State	:	MO
Zip	:	63135-2332
Country	:	US
Telephone Number	:	314-521-1302
Fax Number	:	314-521-5120

Provider Business Practice Location Address
First Line	:	40 N FLORISSANT RD
Second Line	:
City	:	FERGUSON
State	:	MO
Zip	:	63135-2332
Country	:	US
Telephone Number	:	314-521-1302
Fax Number	:	314-521-5120

Authorized Official
Title or Position	:	PHYSICIAN PRESIDENT
Name	:	DR. DONALD A BLUM
Credential	:	MD
Telephone Number	:	314-521-1302

Provider Enumeration Date	:	08/23/2005
Last Update Date	:	08/22/2020

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