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General NPI Number Information
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NPI Number | 1629078688
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Entity Type | Organization
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Legal Business Name | RONALD L JOHNSON
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Dates
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Enumeration Date | 07/29/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 231 W CHERRY ST
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City | WINCHESTER
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State | IL
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Zip | 62694-1027
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Country | US
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Telephone | 217-742-3117
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Fax | 217-742-3988
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Provider Business Mailing Address
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Address Line | 231 W CHERRY ST
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City | WINCHESTER
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State | IL
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Zip | 62694-1027
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Country | US
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Telephone | 217-742-3117
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Fax | 217-742-3988
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. RONALD L JOHNSON
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Credential | MD
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Telephone | 217-285-9661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | 148919
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License Number State | IL
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