Healthcare Provider Details

I. General information

NPI: 1598375610
Provider Name (Legal Business Name): JOHNSON VENTURE MANAGEMENT SOLUTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 03/13/2024
Certification Date: 03/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 LANGLEY BLVD BLDG 1216
HAMPTON VA
23681-2143
US

IV. Provider business mailing address

118 BROADWAY ST STE 621
SAN ANTONIO TX
78205-1981
US

V. Phone/Fax

Practice location:
  • Phone: 757-864-3193
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State

VIII. Authorized Official

Name: MARGIE JOHNSON
Title or Position: CEO/PRESIDENT
Credential:
Phone: 210-504-4707