Healthcare Provider Details

I. General information

NPI: 1942452867
Provider Name (Legal Business Name): JOHNSON ASSOCIATES SYSTEMS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 HONOR HEIGHTS DR
MUSKOGEE OK
74401-1318
US

IV. Provider business mailing address

1011 HONOR HEIGHTS DR
MUSKOGEE OK
74401-1318
US

V. Phone/Fax

Practice location:
  • Phone: 918-577-3542
  • Fax: 918-577-3623
Mailing address:
  • Phone: 918-577-3542
  • Fax: 918-577-3623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License NumberCERT. # CO004446
License Number StateDE

VIII. Authorized Official

Name: MR. KERRY DORIN SCHULTZ
Title or Position: ABC CERTIFIED ORTHOTIST
Credential: CERTIFIED ORTHOTIST
Phone: 918-577-3542