Healthcare Provider Details

I. General information

NPI: 1508686106
Provider Name (Legal Business Name): JOHNSON PROSTHETICS & ORTHOTICS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2024
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1027 S MAIN ST STE LL3
JOPLIN MO
64801-4565
US

IV. Provider business mailing address

1027 S MAIN ST STE LL3
JOPLIN MO
64801-4565
US

V. Phone/Fax

Practice location:
  • Phone: 417-726-9964
  • Fax: 417-622-4449
Mailing address:
  • Phone: 417-726-9964
  • Fax: 417-622-4449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: GREG JOHNSON
Title or Position: OWNER/OPERATOR
Credential: CO, BOCP
Phone: 479-305-9374