Provider Demographics
NPI:1407819022
Name:JOHNSON HEALTHCARE ASSOCIATES INC
Entity Type:Organization
Organization Name:JOHNSON HEALTHCARE ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ART
Authorized Official - Middle Name:
Authorized Official - Last Name:FRETAG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-782-0900
Mailing Address - Street 1:2904 JOHNSON ST NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55418-2234
Mailing Address - Country:US
Mailing Address - Phone:612-782-0900
Mailing Address - Fax:612-788-4930
Practice Address - Street 1:2904 JOHNSON ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55418-2234
Practice Address - Country:US
Practice Address - Phone:612-782-0900
Practice Address - Fax:612-788-4930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2008-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0111978OtherMEDICA
MN1120003OtherMETROPOLITAN HEALTH PLAN
MN70296OtherHEALTHPARTNERS
MN01023902OtherPREFERRED ONE
MN145130800Medicaid
MNP477OtherUCARE
MN55N80JOOtherBLUES
MN038417100Medicaid
MNCB6880OtherRAILROAD MEDICARE
MNC02850Medicare ID - Type UnspecifiedMEDICARE
MN70296OtherHEALTHPARTNERS
MN038417100Medicaid