Provider Demographics
NPI:1013197524
Name:JOHNSON, NEWTON H
Entity Type:Individual
Prefix:
First Name:NEWTON
Middle Name:H
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 FLORENCE DR
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-8538
Mailing Address - Country:US
Mailing Address - Phone:952-470-8818
Mailing Address - Fax:952-470-6936
Practice Address - Street 1:80 FLORENCE DR
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-8538
Practice Address - Country:US
Practice Address - Phone:952-470-8818
Practice Address - Fax:952-470-6936
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0590828Medicaid
MN7G837NEOtherBCBS MN
MN5711339Medicaid
NH30762422Medicaid
WI41695700Medicaid
NE10024965300Medicaid
MN1095920001Medicare NSC