Healthcare Provider Details

I. General information

NPI: 1609203538
Provider Name (Legal Business Name): JOHNSON HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2013
Last Update Date: 12/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

582 BLUE RIDGE AVE
BEDFORD VA
24523-2604
US

IV. Provider business mailing address

134 ELON RD
MADISON HEIGHTS VA
24572-2536
US

V. Phone/Fax

Practice location:
  • Phone: 434-929-1400
  • Fax: 434-929-0410
Mailing address:
  • Phone: 434-455-2480
  • Fax: 434-455-2487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY CAMPBELL
Title or Position: CEO
Credential:
Phone: 434-455-2480