MEDICARE: JOHNSON MEDICAL PLC

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	208M00000X	Hospitalist Physician	42099	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	42099	OTHER	AZ	AZ LICENSE

General Provider Information

NPI Number	:	1740562834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHNSON MEDICAL PLC

Provider Business Mailing Address
First Line	:	PO BOX 5793
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85261-5793
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 NORTH NAVAJO DRIVE
Second Line	:
City	:	PAGE
State	:	AZ
Zip	:	86040-1447
Country	:	US
Telephone Number	:	702-453-3799
Fax Number	:	702-453-5741

Authorized Official
Title or Position	:	ACCOUNTS MGR
Name	:	LORI LABRECQUE
Credential	:
Telephone Number	:	702-453-3799

Provider Enumeration Date	:	09/14/2011
Last Update Date	:	09/15/2011

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Directions to “JOHNSON MEDICAL PLC ” Practice Location

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