Provider Demographics
NPI:1093708240
Name:THE DR ROY JOHNSON MEDICAL CENTER INC
Entity Type:Organization
Organization Name:THE DR ROY JOHNSON MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-521-1302
Mailing Address - Street 1:40 N FLORISSANT RD
Mailing Address - Street 2:
Mailing Address - City:FERGUSON
Mailing Address - State:MO
Mailing Address - Zip Code:63135-2332
Mailing Address - Country:US
Mailing Address - Phone:314-521-1302
Mailing Address - Fax:314-521-5120
Practice Address - Street 1:40 N FLORISSANT RD
Practice Address - Street 2:
Practice Address - City:FERGUSON
Practice Address - State:MO
Practice Address - Zip Code:63135-2332
Practice Address - Country:US
Practice Address - Phone:314-521-1302
Practice Address - Fax:314-521-5120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty