MEDICARE: JOHNSON HEALTH CENTER

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	261QC1500X	Community Health Clinic/Center

General Provider Information

NPI Number	:	1609203538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHNSON HEALTH CENTER

Provider Business Mailing Address
First Line	:	134 ELON RD
Second Line	:
City	:	MADISON HEIGHTS
State	:	VA
Zip	:	24572-2536
Country	:	US
Telephone Number	:	434-455-2480
Fax Number	:	434-455-2487

Provider Business Practice Location Address
First Line	:	582 BLUE RIDGE AVE
Second Line	:
City	:	BEDFORD
State	:	VA
Zip	:	24523-2604
Country	:	US
Telephone Number	:	434-929-1400
Fax Number	:	434-929-0410

Authorized Official
Title or Position	:	CEO
Name	:	MR. GARY CAMPBELL
Credential	:
Telephone Number	:	434-455-2480

Provider Enumeration Date	:	10/10/2013
Last Update Date	:	12/19/2016

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Directions to “JOHNSON HEALTH CENTER ” Practice Location

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