MEDICARE: JEREMY M JOHNSTON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35094426	OH
2	207Q00000X	Family Medicine Physician	55888	KY

General Provider Information

NPI Number	:	1023283835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEREMY M JOHNSTON MD

Provider Business Mailing Address
First Line	:	237 WILLIAM HOWARD TAFT RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45219-2610
Country	:	US
Telephone Number	:	513-351-9900
Fax Number	:	513-366-4491

Provider Business Practice Location Address
First Line	:	1955 DIXIE HWY
Second Line	:
City	:	FT WRIGHT
State	:	KY
Zip	:	41011-2792
Country	:	US
Telephone Number	:	859-341-6255
Fax Number	:	859-547-1197

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	01/21/2022

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