Provider Demographics
NPI:1336145796
Name:JOHNSON MEMORIAL HEALTH SERVICES
Entity Type:Organization
Organization Name:JOHNSON MEMORIAL HEALTH SERVICES
Other - Org Name:DAWSON CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OFFICE
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:320-312-2118
Mailing Address - Street 1:1282 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:DAWSON
Mailing Address - State:MN
Mailing Address - Zip Code:56232-2333
Mailing Address - Country:US
Mailing Address - Phone:320-769-4393
Mailing Address - Fax:320-769-2972
Practice Address - Street 1:1282 WALNUT ST
Practice Address - Street 2:
Practice Address - City:DAWSON
Practice Address - State:MN
Practice Address - Zip Code:56232
Practice Address - Country:US
Practice Address - Phone:320-769-4393
Practice Address - Fax:320-769-2972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-21
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN692320800Medicaid
MN243979Medicare ID - Type UnspecifiedDAWSON CLINIC MEDICARE