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General NPI Number Information
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NPI Number | 1528261872
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Entity Type | Organization
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Legal Business Name | M COLE JOHNSON, INC
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Dates
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Enumeration Date | 06/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 526 SHOUP AVE W SUITE E
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City | TWIN FALLS
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State | ID
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Zip | 83301-5050
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Country | US
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Telephone | 208-733-1112
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Fax | 208-732-1212
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Provider Business Mailing Address
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Address Line | 526 SHOUP AVE W SUITE E
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City | TWIN FALLS
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State | ID
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Zip | 83301-5050
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Country | US
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Telephone | 208-733-1112
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Fax | 208-732-1212
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Authorized Official
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Title or Position | OWNER
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Name | DR. MAYBEN COLE JOHNSON
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Credential | D.O
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Telephone | 208-733-1112
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | O278
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License Number State | ID
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