Healthcare Provider Details

I. General information

NPI: 1740562834
Provider Name (Legal Business Name): JOHNSON MEDICAL PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2011
Last Update Date: 09/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 NORTH NAVAJO DRIVE
PAGE AZ
86040-1447
US

IV. Provider business mailing address

PO BOX 5793
SCOTTSDALE AZ
85261-5793
US

V. Phone/Fax

Practice location:
  • Phone: 702-453-3799
  • Fax: 702-453-5741
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number42099
License Number StateAZ

VIII. Authorized Official

Name: LORI LABRECQUE
Title or Position: ACCOUNTS MGR
Credential:
Phone: 702-453-3799