Healthcare Provider Details

I. General information

NPI: 1184302200
Provider Name (Legal Business Name): JAMARION J JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2023
Last Update Date: 01/24/2024
Certification Date: 01/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 CARDINAL WAY UNIT 900
ST. LOUIS MO
63102
US

IV. Provider business mailing address

6 CARDINAL WAY UNIT 900
SAINT LOUIS MO
63102-3979
US

V. Phone/Fax

Practice location:
  • Phone: 314-665-8522
  • Fax:
Mailing address:
  • Phone: 314-665-8522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code385HR2050X
TaxonomyRespite Care Camp
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: