Provider Demographics
NPI:1053321331
Name:PHIL JOHNSON GEN PTR
Entity Type:Organization
Organization Name:PHIL JOHNSON GEN PTR
Other - Org Name:FOOT SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-682-1311
Mailing Address - Street 1:3540 RIVERSIDE PLAZA DR
Mailing Address - Street 2:SUITE 306
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2709
Mailing Address - Country:US
Mailing Address - Phone:951-682-1311
Mailing Address - Fax:951-682-0111
Practice Address - Street 1:3540 RIVERSIDE PLAZA DR
Practice Address - Street 2:SUITE 306
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2709
Practice Address - Country:US
Practice Address - Phone:951-682-1311
Practice Address - Fax:951-682-0111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies