Healthcare Provider Details

I. General information

NPI: 1255338232
Provider Name (Legal Business Name): JOHNSON HEALTH CARE, INC. DBA JOHNSON SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 HAZARD AVE
ENFIELD CT
06082-4520
US

IV. Provider business mailing address

24 BATTLE ST P.O. BOX 750
SOMERS CT
06071-1629
US

V. Phone/Fax

Practice location:
  • Phone: 860-763-7650
  • Fax:
Mailing address:
  • Phone: 860-684-8417
  • Fax: 860-684-8420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0066
License Number StateCT

VIII. Authorized Official

Name: MR. ANTHONY VALENTE
Title or Position: VICE PRESIDENT
Credential:
Phone: 860-763-7667