Healthcare Provider Details

I. General information

NPI: 1750456901
Provider Name (Legal Business Name): STEVEN P. JOHNSON, MD, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 WINDWARD WAY SUITE 101
KALISPELL MT
59901-2619
US

IV. Provider business mailing address

202 CONWAY DR SUITE 100
KALISPELL MT
59901-3112
US

V. Phone/Fax

Practice location:
  • Phone: 406-756-8488
  • Fax: 406-257-4663
Mailing address:
  • Phone: 406-752-5656
  • Fax: 406-755-0971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number8603
License Number StateMT

VIII. Authorized Official

Name: STEVEN P. JOHNSON
Title or Position: OWNER
Credential: MD
Phone: 406-257-4479