Provider Demographics
NPI:1740245638
Name:JOHNSTON, SARA L (MD)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:L
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:L
Other - Last Name:PECKHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:520 S SANTA FE AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-4190
Mailing Address - Country:US
Mailing Address - Phone:785-823-7470
Mailing Address - Fax:785-452-7530
Practice Address - Street 1:520 S SANTA FE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-4190
Practice Address - Country:US
Practice Address - Phone:785-823-7470
Practice Address - Fax:785-452-7530
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0429451208M00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100457130CMedicaid
KS100457130CMedicaid
KSH53582Medicare UPIN