MEDICARE: MATTHEW EUGENE JOHNSON M.D.

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	207R00000X	Internal Medicine Physician	22580	NE
2	207RC0000X	Cardiovascular Disease Physician	22580	NE
3	207RI0011X	Interventional Cardiology Physician	22580	NE

General Provider Information

NPI Number	:	1578536488
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW EUGENE JOHNSON M.D.

Provider Business Mailing Address
First Line	:	1600 S 48TH ST
Second Line	:	SUITE 600
City	:	LINCOLN
State	:	NE
Zip	:	68506-1275
Country	:	US
Telephone Number	:	402-483-3333
Fax Number	:	402-483-3297

Provider Business Practice Location Address
First Line	:	1600 S 48TH ST
Second Line	:	SUITE 600
City	:	LINCOLN
State	:	NE
Zip	:	68506-1275
Country	:	US
Telephone Number	:	402-483-3333
Fax Number	:	402-483-3297

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

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	02/24/2012

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