Provider Demographics
NPI:1356511430
Name:DR. CHRISTOPHER W. JOHNSON, D.P.M., PA
Entity Type:Organization
Organization Name:DR. CHRISTOPHER W. JOHNSON, D.P.M., PA
Other - Org Name:PODIATRY HOME CARE, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:W
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:954-986-1090
Mailing Address - Street 1:5640 FARRAGUT ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-2721
Mailing Address - Country:US
Mailing Address - Phone:954-986-1090
Mailing Address - Fax:954-894-9093
Practice Address - Street 1:5640 FARRAGUT ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-2721
Practice Address - Country:US
Practice Address - Phone:954-986-1090
Practice Address - Fax:954-894-9093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2947332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1043383037OtherNPI
FLBJ7429916OtherDEA
FLBJ7429916OtherDEA
FLE5982Medicare PIN
FL4293240001Medicare NSC