Provider Demographics
NPI:1750468765
Name:JAMES F JOHNSON, MD, PC
Entity Type:Organization
Organization Name:JAMES F JOHNSON, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:FRED
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-241-9300
Mailing Address - Street 1:2301 25TH ST S
Mailing Address - Street 2:SUITE I
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-6104
Mailing Address - Country:US
Mailing Address - Phone:701-241-9300
Mailing Address - Fax:701-235-4525
Practice Address - Street 1:2301 25TH ST S
Practice Address - Street 2:SUITE I
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-6104
Practice Address - Country:US
Practice Address - Phone:701-241-9300
Practice Address - Fax:701-235-4525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3782174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND14556Medicaid
MN58A10J0OtherMN BC BS
9809329OtherMEDICA
ND01076001OtherND BC BS
SD6402130Medicaid
SD0023210OtherWELLMARK BCBS
MN414453000Medicaid
52234OtherHEALTH PARTNERS
DG2494OtherRR MEDICARE
ND14556Medicaid
NDN711213Medicare PIN
52234OtherHEALTH PARTNERS
SDS41161Medicare PIN