Provider Demographics
NPI:1376838110
Name:LINDA L. JOHNSON MD, LTD
Entity Type:Organization
Organization Name:LINDA L. JOHNSON MD, LTD
Other - Org Name:SMA CONVENIENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SMA PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-560-2886
Mailing Address - Street 1:2720 N TENAYA WAY
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0424
Mailing Address - Country:US
Mailing Address - Phone:702-560-2889
Mailing Address - Fax:702-560-2928
Practice Address - Street 1:300 E LAKE MEAD PKWY
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89015-5576
Practice Address - Country:US
Practice Address - Phone:702-560-2915
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-09
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1376838110Medicaid
NV1376838110Medicaid