Provider Demographics
NPI:1740334432
Name:JOHNSON'S AUDITORY SALES & SERVICE, INC.
Entity type:Organization
Organization Name:JOHNSON'S AUDITORY SALES & SERVICE, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEARING AID DISPENSER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:WELL
Authorized Official - Suffix:
Authorized Official - Credentials:BC-HIS
Authorized Official - Phone:618-259-0700
Mailing Address - Street 1:975 E EDWARDSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:WOOD RIVER
Mailing Address - State:IL
Mailing Address - Zip Code:62095-1823
Mailing Address - Country:US
Mailing Address - Phone:618-259-0700
Mailing Address - Fax:
Practice Address - Street 1:975 E EDWARDSVILLE RD
Practice Address - Street 2:
Practice Address - City:WOOD RIVER
Practice Address - State:IL
Practice Address - Zip Code:62095-1823
Practice Address - Country:US
Practice Address - Phone:618-259-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147-000405231H00000X
IL1657237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========001Medicaid