Provider Demographics
NPI:1649482951
Name:JAY C. JOHNSTON, M. D., INC
Entity type:Organization
Organization Name:JAY C. JOHNSTON, M. D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE
Authorized Official - Prefix:
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITENER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-749-4280
Mailing Address - Street 1:4200 W MEMORIAL RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-9350
Mailing Address - Country:US
Mailing Address - Phone:405-749-4280
Mailing Address - Fax:405-749-4281
Practice Address - Street 1:4200 W MEMORIAL RD
Practice Address - Street 2:SUITE 101
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-9350
Practice Address - Country:US
Practice Address - Phone:405-749-4280
Practice Address - Fax:405-749-4281
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2009-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8645174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK180022180Medicare ID - Type UnspecifiedRAILROAD MEDICARE
OKD34866Medicare UPIN
OK=========Medicare ID - Type Unspecified