Provider Demographics
NPI:1659463867
Name:JAMES P JOHNSTON D O INC
Entity Type:Organization
Organization Name:JAMES P JOHNSTON D O INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:P
Authorized Official - Last Name:JOHNSTON
Authorized Official - Suffix:
Authorized Official - Credentials:D O
Authorized Official - Phone:740-754-2671
Mailing Address - Street 1:5063 DRESDEN CT
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-7695
Mailing Address - Country:US
Mailing Address - Phone:740-453-9173
Mailing Address - Fax:
Practice Address - Street 1:304 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:DRESDEN
Practice Address - State:OH
Practice Address - Zip Code:43821-9590
Practice Address - Country:US
Practice Address - Phone:740-754-2671
Practice Address - Fax:740-754-1812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007193J207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2139733Medicaid
OHJ00889683Medicare ID - Type UnspecifiedMEDICARE NUMBER
OH2139733Medicaid