Healthcare Provider Details

I. General information

NPI: 1649690280
Provider Name (Legal Business Name): JOHNSON HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2014
Last Update Date: 04/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10916 S SANGAMON ST
CHICAGO IL
60643-3836
US

IV. Provider business mailing address

10916 S SANGAMON ST
CHICAGO IL
60643-3836
US

V. Phone/Fax

Practice location:
  • Phone: 800-641-6130
  • Fax:
Mailing address:
  • Phone: 800-641-6130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberD4B3A5A9
License Number StateIL

VIII. Authorized Official

Name: MS. DONNA M JOHNSON
Title or Position: OWNER/OPERATOR
Credential: PHLEBOTOMIST
Phone: 800-641-6130