Provider Demographics
NPI:1801903950
Name:JOHNSON PATIENT-CARE SUPPLIES INC
Entity type:Organization
Organization Name:JOHNSON PATIENT-CARE SUPPLIES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHIELA
Authorized Official - Middle Name:DAWN
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MA CMRT
Authorized Official - Phone:936-334-1545
Mailing Address - Street 1:PO BOX 117
Mailing Address - Street 2:
Mailing Address - City:MONT BELVIEU
Mailing Address - State:TX
Mailing Address - Zip Code:77580
Mailing Address - Country:US
Mailing Address - Phone:936-334-1545
Mailing Address - Fax:936-334-1558
Practice Address - Street 1:619 MAIN ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:TX
Practice Address - Zip Code:77575-4811
Practice Address - Country:US
Practice Address - Phone:936-334-1545
Practice Address - Fax:936-334-1558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-24
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX087210301Medicaid
TX0379790001Medicare NSC