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NPI Code Detail

MEDICARE: HENRY A JOHNSON

MEDICARE: HENRY A JOHNSON
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
11744P3200XProsthetics Case Management

General Provider Information

NPI Number : 1487433306
Entity Type Code : Individual
Provider Name (Legal Business Name) : HENRY A JOHNSON
Provider Business Mailing Address
First Line : 595 E BROOKS AVE STE 313
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89030-3975
Country : US
Telephone Number : 702-272-2824
Fax Number :
Provider Business Practice Location Address
First Line : 1807 W CRAIG RD
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89032-0217
Country : US
Telephone Number : 248-259-0246
Fax Number : 248-547-2440
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/28/2023
Last Update Date : 09/28/2023

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