Provider Demographics
NPI:1346432556
Name:BLANE JOHNSON, LLC
Entity Type:Organization
Organization Name:BLANE JOHNSON, LLC
Other - Org Name:FOOT SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BLANE
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-525-3382
Mailing Address - Street 1:939 S 25TH E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-5734
Mailing Address - Country:US
Mailing Address - Phone:208-525-3338
Mailing Address - Fax:208-525-3339
Practice Address - Street 1:939 S 25TH E
Practice Address - Street 2:SUITE 100
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-5734
Practice Address - Country:US
Practice Address - Phone:208-525-3338
Practice Address - Fax:208-525-3339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID5986300001Medicare NSC