Provider Demographics
NPI:1508231036
Name:JOHNSON HEALTH CENTER
Entity Type:Organization
Organization Name:JOHNSON HEALTH CENTER
Other - Org Name:AMELON SQUARE IMMEDIATE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:434-947-5967
Mailing Address - Street 1:PO BOX 4649
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23058-4649
Mailing Address - Country:US
Mailing Address - Phone:434-947-5967
Mailing Address - Fax:434-455-2486
Practice Address - Street 1:200 AMELON SQ
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:24572-5981
Practice Address - Country:US
Practice Address - Phone:434-949-1400
Practice Address - Fax:434-947-5971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)