Provider Demographics
NPI:1710261771
Name:JOHNSON MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:JOHNSON MEDICAL GROUP PLLC
Other - Org Name:CAMPBELL MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:K
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-468-3155
Mailing Address - Street 1:1012 CAMPBELL RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77055-7408
Mailing Address - Country:US
Mailing Address - Phone:713-468-3155
Mailing Address - Fax:281-809-7001
Practice Address - Street 1:1012 CAMPBELL RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-7408
Practice Address - Country:US
Practice Address - Phone:281-978-2502
Practice Address - Fax:832-358-2226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-07
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2046208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB143289Medicare PIN