Healthcare Provider Details

I. General information

NPI: 1669779567
Provider Name (Legal Business Name): DOUGLAS T. JOHNSON & ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2011
Last Update Date: 03/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WASHINGTON AVE SUITE 152
GRAND HAVEN MI
49417-1354
US

IV. Provider business mailing address

PO BOX 631
GRAND HAVEN MI
49417-0631
US

V. Phone/Fax

Practice location:
  • Phone: 616-604-4850
  • Fax: 616-931-5584
Mailing address:
  • Phone: 616-604-4850
  • Fax: 616-931-5584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. DOUGLAS T JOHNSON
Title or Position: CEO
Credential:
Phone: 616-604-4850