Provider Demographics
NPI:1528404415
Name:JOHNSTON SPECIALTY PHYSICIAN SERVICES, INC.
Entity Type:Organization
Organization Name:JOHNSTON SPECIALTY PHYSICIAN SERVICES, INC.
Other - Org Name:JOHNSTON MEDICAL ASSOCIATES SPECIALTY SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOORUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-938-7374
Mailing Address - Street 1:507 N BRIGHTLEAF BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SMITHFIELD
Mailing Address - State:NC
Mailing Address - Zip Code:27577-4405
Mailing Address - Country:US
Mailing Address - Phone:919-934-3022
Mailing Address - Fax:919-934-4133
Practice Address - Street 1:507 N BRIGHTLEAF BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:SMITHFIELD
Practice Address - State:NC
Practice Address - Zip Code:27577-4405
Practice Address - Country:US
Practice Address - Phone:919-934-3022
Practice Address - Fax:919-934-4133
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-17
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Single Specialty