Healthcare Provider Details

I. General information

NPI: 1023898186
Provider Name (Legal Business Name): JOHNSONS CLINICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2023
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 W 15TH ST STE 1
HAZLETON PA
18201-2783
US

IV. Provider business mailing address

901 W 15TH ST STE 1
HAZLETON PA
18201-2783
US

V. Phone/Fax

Practice location:
  • Phone: 570-708-4451
  • Fax:
Mailing address:
  • Phone: 570-708-4451
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: ROBERT J HINKLE
Title or Position: OWNER
Credential: PHARMD
Phone: 570-708-4451