Provider Demographics
NPI:1346582947
Name:JOHNSON'S ORTHOTICS & PROSTHETICS, LLC
Entity Type:Organization
Organization Name:JOHNSON'S ORTHOTICS & PROSTHETICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:BOCPO
Authorized Official - Phone:317-272-9993
Mailing Address - Street 1:941 25TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-4276
Mailing Address - Country:US
Mailing Address - Phone:812-372-2800
Mailing Address - Fax:812-418-8148
Practice Address - Street 1:941 25TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-4276
Practice Address - Country:US
Practice Address - Phone:812-372-2800
Practice Address - Fax:812-418-8148
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-21
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier