Provider Demographics
NPI:1508686106
Name:JOHNSON PROSTHETICS & ORTHOTICS LLC
Entity type:Organization
Organization Name:JOHNSON PROSTHETICS & ORTHOTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:GREG
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CO, BOCP
Authorized Official - Phone:479-305-9374
Mailing Address - Street 1:1027 S MAIN ST STE LL3
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-4565
Mailing Address - Country:US
Mailing Address - Phone:417-726-9964
Mailing Address - Fax:417-622-4449
Practice Address - Street 1:1027 S MAIN ST STE LL3
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-4565
Practice Address - Country:US
Practice Address - Phone:417-726-9964
Practice Address - Fax:417-622-4449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-16
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
Yes335E00000XSuppliersProsthetic/Orthotic SupplierGroup - Multi-Specialty