Provider Demographics
NPI:1508975145
Name:RICK JOHNSON, D.O., P.A.
Entity Type:Organization
Organization Name:RICK JOHNSON, D.O., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:785-473-7060
Mailing Address - Street 1:2317 WILDWOOD LN
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-3610
Mailing Address - Country:US
Mailing Address - Phone:785-473-6848
Mailing Address - Fax:785-263-3979
Practice Address - Street 1:2317 WILDWOOD LN
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-3610
Practice Address - Country:US
Practice Address - Phone:785-473-6848
Practice Address - Fax:785-263-3979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-21868207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100235990AMedicaid
KS040648OtherBLUECROSS/BLUE SHIELD
E73395Medicare UPIN
KS040648OtherBLUECROSS/BLUE SHIELD