Provider Demographics
NPI:1235215815
Name:JOHNSTON ORTHOPEDIC & MEDICAL SUPPLY, INC.
Entity Type:Organization
Organization Name:JOHNSTON ORTHOPEDIC & MEDICAL SUPPLY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:STEWART
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-843-2488
Mailing Address - Street 1:2801 SHATTUCK AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-1010
Mailing Address - Country:US
Mailing Address - Phone:510-843-2488
Mailing Address - Fax:510-843-7578
Practice Address - Street 1:2801 SHATTUCK AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1010
Practice Address - Country:US
Practice Address - Phone:510-843-2488
Practice Address - Fax:510-843-7578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101937332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0742390001Medicare ID - Type Unspecified