Provider Demographics
NPI:1255338232
Name:JOHNSON HEALTH CARE, INC. DBA JOHNSON SURGERY CENTER
Entity type:Organization
Organization Name:JOHNSON HEALTH CARE, INC. DBA JOHNSON SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:VALENTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:860-763-7667
Mailing Address - Street 1:24 BATTLE ST
Mailing Address - Street 2:P.O. BOX 750
Mailing Address - City:SOMERS
Mailing Address - State:CT
Mailing Address - Zip Code:06071-1629
Mailing Address - Country:US
Mailing Address - Phone:860-684-8417
Mailing Address - Fax:860-684-8420
Practice Address - Street 1:148 HAZARD AVE
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-4520
Practice Address - Country:US
Practice Address - Phone:860-763-7650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0066261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTIR0098OtherHEALTH NET PROVIDER NUMBE
CTA487059OtherOXFORD PROVIDER NUMBER
CT122OtherANTHEM BC/BS PROVIDER NUM
CT775436OtherCONNECTICARE PROVIDER NUM