MEDICARE: MR. JAMES EDWARD JOHNSON III RSA, CSA, SA-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
1	246ZC0007X	Surgical Assistant	238.000140	IL
2	246ZS0410X	Surgical Technologist	238.000140	IL

General Provider Information

NPI Number	:	1942342761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES EDWARD JOHNSON III RSA, CSA, SA-C

Provider Business Mailing Address
First Line	:	7324 SOUTHWEST FREEWAY
Second Line	:	SUITE 1550
City	:	HOUSTON
State	:	TX
Zip	:	77074-2053
Country	:	US
Telephone Number	:	713-779-9800
Fax Number	:	713-779-9813

Provider Business Practice Location Address
First Line	:	7324 SOUTHWEST FREEWAY
Second Line	:	SUITE 1550
City	:	HOUSTON
State	:	TX
Zip	:	77074-2053
Country	:	US
Telephone Number	:	713-779-9800
Fax Number	:	713-779-9813

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

Provider Enumeration Date	:	02/12/2007
Last Update Date	:	02/18/2014

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Directions to “ MR. JAMES EDWARD JOHNSON III RSA, CSA, SA-C” Practice Location

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