Provider Demographics
NPI:1962690008
Name:RUTH A. JOHNSON
Entity Type:Organization
Organization Name:RUTH A. JOHNSON
Other - Org Name:THE GALLERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-336-1155
Mailing Address - Street 1:701 N MAIN ST
Mailing Address - Street 2:PO BOX 1114
Mailing Address - City:LAMAR
Mailing Address - State:CO
Mailing Address - Zip Code:81052-2207
Mailing Address - Country:US
Mailing Address - Phone:719-336-1155
Mailing Address - Fax:
Practice Address - Street 1:701 N MAIN ST
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:CO
Practice Address - Zip Code:81052-2207
Practice Address - Country:US
Practice Address - Phone:719-336-1155
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO26777290000332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies