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NPI Code Detail

MEDICARE: CHARLES E JOHNSON PA-C

MEDICARE: CHARLES E JOHNSON PA-C
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
1363A00000XPhysician AssistantPA-C0149NV

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00865044OTHERNVRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1124090949
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHARLES E JOHNSON PA-C
Provider Business Mailing Address
First Line : PO BOX 98978
Second Line :
City : LAS VEGAS
State : NV
Zip : 89193-8978
Country : US
Telephone Number : 702-507-2419
Fax Number : 702-671-6883
Provider Business Practice Location Address
First Line : 1501 E CALVADA BLVD
Second Line :
City : PAHRUMP
State : NV
Zip : 89048-5807
Country : US
Telephone Number : 775-727-5509
Fax Number : 775-727-5696
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2006
Last Update Date : 01/25/2012

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Directions to “ CHARLES E JOHNSON PA-C” Practice Location

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