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General NPI Number Information
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NPI Number | 1225564826
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Entity Type | Organization
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Legal Business Name | MARK ROLFE JOHNSON MD., P.C.
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Dates
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Enumeration Date | 05/03/2017
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Last Update Date | 05/03/2017
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Provider Practice Location Address
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Address Line | 1899 E SIESTA DR
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City | COTTONWOOD HEIGHTS
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State | UT
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Zip | 84093-6241
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Country | US
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Telephone | 801-631-8210
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Fax | 801-446-1474
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Provider Business Mailing Address
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Address Line | 1899 E SIESTA DR
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City | COTTONWOOD HEIGHTS
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State | UT
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Zip | 84093-6241
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Country | US
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Telephone | 801-631-8210
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Fax | 801-446-1474
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Authorized Official
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Title or Position | PROVIDER
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Name | MARK R JOHNSON
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Credential | MD
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Telephone | 801-631-8210
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 184901-1205
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 184901-1205
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License Number State | UT
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